Royal Customs and Excise Department DECLARANT REGISTRATION FORM

Ministry of Finance
Jalan Menteri Besar. Bandar Seri Begawan BB 3910.
Brunei Darussalam.
Tel : 673-2382333 Fax : 673-2382666 NOTE: Please attach an official letter with company letterhead clearly
describing the application request and a copy of Declarants Identification

SECTION A: APPLICANT DETAILS ( To be filled by applicant )

Identity Card No : Full Name :

Gander : Male Female Designation :

Date of Birth : Email Address :

Telephone No : Mobile No :

Company Registratio No :

Company Name :
Signature : Date :

SECTION B: DECLARANTS ( To be filled by applicant )

1 Add
Identity Card No : Full Name : Action : Remove

Gander : Male Female Designation : Effective Date :

Date of Birth : Email Address :

Acess Rights : Submit Declaration Submit Permit Application Submit Manifest

2 Add
Identity Card No : Full Name : Action : Remove

Gander : Male Female Designation : Effective Date :

Date of Birth : Email Address :

Acess Rights : Submit Declaration Submit Permit Application Submit Manifest

3 Add
Identity Card No : Full Name : Action : Remove

Gander : Male Female Designation : Effective Date :

Date of Birth : Email Address :

Acess Rights : Submit Declaration Submit Permit Application Submit Manifest

SECTION C: REGISTRATION ( fOR OFFICIAL USE )

Registered By : Signature :
Date:

SECTION D: USER ACCOUNT CREATION ( fOR OFFICIAL USE )

Registered By : Signature :
Date: