FORM DECLARATIONS CASH CASH FUNDS EN

Number links

Model No. Flag countries Before filling letterhead read notes on turnover
FILL IN CAPITAL IN LETTERS / NOTE NECESSARY

1. You you are moving in V /…* leaving from EU /…*

EU

2. Personal data Man Woman Place extradition

Surname date extradition D D M M G G G G
Name Private code
Citizenship Address
date birth D D M M G G G G ( Street / No. at home )
Place of Birth City
ID document ID card Another Mail index / Zip code
Passport
No. passports / others _ document A country

3.Owner - You Yes ( go To n . 4) No , owner is : Legal face

( specify data owner ) Physical face
Jurid . face Address
( Street / No. at home )
Number payer VAT City
Surname Mail index / code
Name A country

4. Intelligence O cash monetary means / monetary tools

Amount Currency
banknotes , coins

Other ( specify )

5. Origin And target use cash monetary funds / monetary tools

Origin
Target use
Recipient are Yes ( go To n . 6) No , recipient is : Legal face
You
( specify data recipient ) Physical face
Jurid . face Address
( Street / No. at home )
Number payer VAT City
Surname Mail index / Zip code
Name A country

6. Intelligence about transport

View transport air maritime road railway another
Transport company Reference number
A country departures date departures D D M M G G G G
A country transit date transit D D M M G G G G
A country destination date arrival D D M M G G G G

7. Signature declarant Signature And seal competent body For official marks
I declare that all of the above information is reliable . I'm aware of
which is unreliable inaccurate or incomplete filling of the
declaration entails overlay fines , detention or confiscation On accounting Yes No
cash monetary funds competent bodies .

Fine Yes No

Sum fine
Date :

D D M M G G G G
ARE COMMON INTELLIGENCE:

Duty declare cash monetary facilities at entry V European Union And departure from European Union is part strategies European Union By
prevention laundering money And fight With funding terrorists. … …
where _ This applicable For Member State With duty declare cash monetary facilities inside EU: link on national law ."

You must complete this form if you are entering or leaving the European Union with cash funds of EUR 10,000 or more (or equivalent in other
currencies) [Regulation (EC) No 1889/2005, Article 3(1)] And… "Where This applicable For Member State With duty declare availability
inside EU: link on national legislation ."

According to Article 2 (2) Regulations (EC) No. 1889/2005, necessary declare:

a) negotiable monetary documentation on bearer, V including such monetary tools on bearer How traveler's checks, negotiable documents
(including checks, bills of exchange and payment orders) issued to the bearer, endorsed without restrictions, issued to a fictitious recipient, or in
another form, involving the transfer of ownership by delivery, as well as incomplete documents (including cheques, bills of exchange and money
orders) signed but not named recipient
b) currency (banknotes And coins, located V circulation How means exchange).

"Where necessary, specify additional national requirements To others values"

indication unreliable, imprecise or incomplete information counts non-compliance the above responsibilities And entails entail the imposition of
fines on the signatory or the detention/confiscation of cash by the competent authorities according to … reference to current national
legislation and Articles 3(1) and 9(1) of Regulation (EC) No. 1889/2005. Information and personal data are registered and processed by the
competent authorities [Regulation (EC) No. 1889/2005, Article 5(1)] and may be provided to the services referred to in Article 22 of Directive
2005/60/EC. Data processing carried out V accordance With applicable rules protection data. Where necessary - link on national legislation O
protection data

EXPLANATIONS

All white fields are filled in by the declarant in capital letters in dark ink (where necessary, one letter/number in each cage) ; gray fields are filled
competent bodies .
1. Are you moving in V EU/ …* And leaving from EU /……*
Check « You are moving in V EU / …. * ", If You you are moving in V European Union / …* , And Your drive started behind outside
European Union / …*.
Check " You are leaving EU / …* ”, if you leave the European Union / …* , and your trip should finish in outside the European Union /…*. You
must fill out a declaration at the time of entry and exit, even in the case of transit . Please be aware that you may be required to complete
additional declarations V others paragraphs intersections state borders on way Your his following .

2. Personal data declarant

Specify the information specified in the document proof of your identity ( the competent authorities may make a copy of your certificates
personalities and / or your travel cards documents ).
Personal code : enter your taxpayer identification number , personal social security number or similar unique private identificational
number .
3. Personal data owner
If you are not the owner of the cash , please provide the owner 's details . The owner may be an individual or legal entity . Check the
appropriate box and enter the data . Specify the registration number of the tax payer for value added ( VAT ), if you know it . If there is
more than one owner , enter the details of the other owners in application . To do this, you can use an additional instance of the
declaration . All information will form a single declaration . All attached pages must be signed .

4. Intelligence O currency/negotiable monetary documents on bearer

Specify the exact amount in each currency and for each type of negotiable bearer banknotes . Information must be in the following format :
for example EUR 10,358 , USD 17,501 or GB 19,471.18 POUNDS or road checks on amount 15 000 EUR .
As a general rule , all financial documents that can be physically and anonymously transferred from one person to another , correspond
definition cash monetary means : see _ definition higher V section « General information ."

5. Origin And target use cash monetary funds / monetary tools

Origin : Indicate the source of the cash , such as inheritance , savings , sale of property , etc . n . Briefly explain target usage : for example
, acquisition property , investment And t . n .
Appointed recipient Maybe be physical or legal face ( e.g. , company ). Check necessary And write in data . Not forget specify registration
number payer tax on added price ( VAT ), If He To you known .
If recipients several , indicate data the rest recipients V application . For this Can use additional instance declarations . All information will be
single declaration . All attached pages must be signed .

6. Intelligence O transport
Check "air" / when entering / leaving by plane . In the column " Reference number " please enter flight number or aircraft
registration number . Check "marine" / at entry / exit by sea . IN column « Room links » indicate data steamboat lines .
Check "automobile" / at entry / exit any motor transport means ( passenger car , bus , cargo
car , motorbike And etc. ) IN column « Room links » indicate official registration number And code countries transport means . Check "w
/ road" / at entry / exit by train . IN column « Room links » indicate type And number trains . Check
"another" at use others funds movement ( e.g. , on foot , on bicycle ).

7. Signature declarant
Put signature under declaration And indicate date . You you can ask provide to you certified copy declaration .