IE464

UNIT: IMPORT AND EXPORT CONTROL

PRIVATE BAG X 192
PRETORIA 0001
TEL: 012 3943590/1
WWW.ITAC.ORG.ZA

OFFICIAL
FILE NO

APPLICATION FOR PERMIT TO IMPORT

CHEMICALS

NOTE: a) ALL INFORMATION MUST BE PROVIDED

b) FULL TARIFF HEADING CODES MUST BE PROVIDED
c) TO BE COMPLETED IN TYPESCRIPT OR IN BLOCK CAPITALS IN INK

1. IMPORTERS CUSTOMS CODE NUMBER:

2. E-MAIL ADDRESS:

3. NAME OF BUSINESS
OR APPLICANT

4. FULL POSTAL
ADDRESS

5. TELEPHONE NUMBER:

6. CONTACT PERSON:

DETAILS OF CHEMICALS FOR WHICH AN IMPORT PERMIT IS REQUIRED

7. FULL TARIFF HEADING

AND DESCRIPTION

8. WILL CURRENCY N Y 9. RAND VALUE OF PERMIT

BE TRANSFERRED BEING APPLIED FOR

10. QUANTITY R
REQUIRED: KG

11. COUNTRY OF ORIGIN:

I , ………………………………………….. …………… of ….. …...………………………..……………………………

In my capacity as ………………………………………… do hereby solemnly declare that I am authorised to make
this application with annexure on behalf of the applicant named herein and that the information given in this
declaration and annexure is to the best of my knowledge and belief true and correct.

DATE………………………………………….. SIGNATURE……………………………………