Return of Security depositReturn of Security deposit

Return of Security deposit

Address to which advice of payment or cheque for refund of security amount is to be sent:

Address ...............................................................................................…………………………….

……………………………………………………………………………………………………………..

NOTE: a completed Order To Pay Agent form must be presented to Customs if the security deposit is to be refunded to someone other than the person who first gave the security amount.

Please refund the security deposit to me by:

 EFT payment to my nominated bank account; or

 CHEQUE

CUSTOMS USE ONLY:

<table cellspacing="0" cellpadding="0" style="width:519.4pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:13.75pt"><td style="width:232.2pt; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#cccccc"><p style="text-align:center"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">UPON IMPORTATION</span></p></td><td style="width:264.85pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#cccccc"><p style="text-align:center"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">UPON EXPORTATION</span></p></td></tr><tr style="height:232.73pt"><td rowspan="2" style="width:232.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">SECURITY DETAILS</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">*Security amount of:</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">$ .......................................... c ................................…….....</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">may be retained on deposit.</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">*Undertaking for payment of duty may be accepted.</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Payment Consolidation ID:</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">................................................</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Security Sub-Head: ......................................................…...</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Date……… /………/</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">20……….</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Signature ...…………......……………………………………..</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Name of Authorising Officer ...........................……………..</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Title of Authorising Officer…………………………………….</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p></td><td style="width:264.85pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">SECURITY RETURN</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Customs Duty:</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">$ .......................……..... c ....................................</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">*may be returned to depositor</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Customs Duty:</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">$……............................. c .................................…</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">*may be transferred to revenue</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Date…………../……../</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">20……………</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Signature .................................................………………………………...</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Name of Authorising Officer .................................……………………….</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Title of Authorising Officer…………………………………………………..</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p></td></tr><tr style="height:32.25pt"><td rowspan="2" style="width:264.85pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold"></span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">EXAMINATION ON EXPORTATION</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Upon exportation, the goods should be verified against the details listed overleaf.</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">............................................................................................................…</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Examining Officer</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">/</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">/</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">20</span><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p></td></tr><tr style="height:129.3pt"><td style="width:232.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="text-align:center; font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">QSP DETAILS</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Deposit paid into Collector of Customs Security Account:</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">QSP Receipt No………………of……………/…………/ ..20</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Date………../………./</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">20…………..</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Signature ...........................................………………..……</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span><span style="font-family:'Arial Narrow', sans-serif">Cashier</span></p></td></tr><tr><td style="width:232.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">EXAMINATION ON IMPORTATION</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="line-height:150%; font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Import Declaration No. </span><span style="font-family:'Arial Narrow', sans-serif; font-size:8pt">(if applicable)</span><span style="font-family:'Arial Narrow', sans-serif"> :</span></p><p class="BodyText3" style="line-height:150%"><span>………………………………………………………………...</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">............................................................…………………….</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif">Examining Officer</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">/</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">/</span><span style="font-family:'Arial Narrow', sans-serif"> </span><span style="font-family:'Arial Narrow', sans-serif">20</span><span style="font-family:'Arial Narrow', sans-serif"></span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p></td><td style="width:264.85pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><p style="font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold"></span></p><p style="font-size:11pt"><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold"></span><span style="font-family:'Arial Narrow', sans-serif; font-weight:bold">ADDITIONAL COMMENTS:</span></p><p style="font-size:10pt"><span style="font-family:'Arial Narrow', sans-serif"></span></p></td></tr></tbody></table>