FORM - A - Application Form for Grant of Customs Broker’s Licence under section 146 of the Customs Act, 1962 - (see sub-regulation (1) of regulation 4) - Customs Brokers Licensing Regulations, 2013

Form A [see sub-regulation (1) of regulation 4] Application Form for Grant of Customs Broker s Licence under section 146 of the Customs Act, 1962 1. Name of the applicant :- 2. Full address of the applicant :- 3. Names and address of each of the partners of the firm or the directors of the company, as the case may be, in case the applicant is a firm or a company :- 4. Name(s) of its partner/partners or director/directors who will actually be engaged in the work as Customs Broker, in case the applicant is a firm or a company:- 5. Educational qualification of each of the persons, who may be engaged as Customs Broker:- Declaration: a. I have working knowledge of English/ local language ( .) /Hindi. b. I have not earlier applied for a licence to act as Customs Broker and no such application was rejected/accepted. c. The firm or company by whom the undersigned is employed have earlier held a Customs House Agent or Customs Broker's Licence under Customs House Licensing Regulation, 1984 or Customs House Licensing Regulation, 2004 or these regulations and it was cancelled or suspended/not cancelled or suspended. d. The undersigned / the person proposed to be employed by me have been/have not been penalised, convicted or prosecuted under any of the provisions of the Customs Act, 1962 (52 of 1962) , the Central Excise Act 1944 (1 of 1994), and the Finance Act, 1944. List of documents furnished in accordance with regulation 5 Customs Brokers Licensing Regulation, 2013: S. No. Educational Financial 1. 2. 3. 4. I/We hereby affirm the I/we have read the Customs Brokers Licensing Regulations, 2013 and agree to abide by them. Date: Signature of applicant