GENERAL DEPARTMENT OF CUSTOMS AND EXCISE

Passenger’s Declaration

Family Name

Given Names

Sex Male / Female

Date of Birth

Passport No.

Nationality

Occupation

Flight No.

From/To

Please Check

Goods to declare / Nothing to declare

If you have goods to declare please list them on the reverse side.

You are carrying foreign currency or monetary instruments over $10,000U.S. or its equivalent.

Yes No

I certify that all statements on this declaration are true and correct.

Signature

Date Day Month Year

If you have any question, please ask a customs officer.