PASSENGER CUSTOMS DECLARATION

Basic document
* To be filled by persons over 16
* To answer mark a cross in the appropriate box below x
* Keep for the whole duration of your stay temporary abroad\ in the country and submit to the customs on your
way back

entry exit
1. Information on traveler:
family name first name second name
Series no.
Country of permanent residence nationality/citizenship document establishing one’s identity

Arrived from (country of departure) Leaving for (country of destination)

With me I have children under age Number

Yes No
With me or to me goods or transportation are carried which are due to be declared
2. Information of goods and transportation modes of carriage:
2.1. Accompanied 2.2. Unaccompanied 2.3. Goods, delivered by
luggage Yes No luggage Yes No carrier Yes No
pieces pieces pieces
3. Information on merchandise and vehicles:
3.1. Currency of state members of the Customs union, foreign currency,
traveller cheques not exceeding an equivalent of $10000 US Yes No
(to be filled optional)
Description Total sum
In figures In words

3.2. Currency of state members of the Customs union, foreign currency, traveller
cheques over an equivalent of $10000 US circulating notes, (bank) cheque, securities Yes No
to bearer
3.3. Information on transport unit
Yes No
Registration no. Body no. or
Moment of identification
Model release number
Engine volume (in cub cent) Chassis no. Customs value
Direction of transportation: importation temporary importation
exportation reexportation
Taken off the registration at the country of previous registration
Yes No

3.4. Goods, forbidden of limited

Yes No
3.5. Indivisible goods over 35 kilos, goods with total weight over 50 kilos and/or
total customs value over €1500 Yes No
4. Information of good, mentioned in 3.4, 3.5, which are due to be declared, and other goods
(optional):
Item Description and other merchandise feature, Quantity Value in
permit number, date of issue and issuing authority currency of state
In figures In words members of the
Customs union,
USD or euro

Total value and quantity ( total)

I am aware that giving false information in the Customs declaration shall render myself liable
under acting legislation of the state member of the customs union

“____” ________________ _____ Signature _________________

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For office use only

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 Annex to customs declaration

PASSENGER CUSTOMS DECLARATION

Additional document «Cash and (or) monetary instruments declaration form»

To be filled by persons over 16 entering of leaving customs territory of the customs union:
- cash (Banknotes, coins, except coins made of precious metal), traveler cheques over cheques over an
equivalent of $10000 US;
- other monetary instruments in document form (bill of exchange, (bank) cheques, securities to bearer )
Filling the document a person has to mention every cash, traveler’s cheques and monetary instrument
movement

Type of declaration entering customs territory of the customs union leaving customs territory of the customs union

1. Information on traveler
family name (last name) first name second name

date and place of birth (dd/mm/y\yy) nationality/citizenship country of permanent residence

document establishing one's identity series, no date and place of issue

address of permanent residence address of registration at the customs territory number and date of visa issuing (document
certifying right to stay at the territory of the
customs) union

2. Information on cash and monetary instruments

2.1 Cash and traveller cheques

Amount Currency
Banknote, coins

Traveller cheque

2.2. Monetary instruments except traveller cheque (bill of exchange, (bank) cheques, securities to beare
and other)

Type of Issuing Date of issue Identification number Amount Value

instruments authority (if any)
3. Details of owner of cash and (or) monetary instruments
declarant other natural person other person

3.1. Details of owner of cash and (or) monetary instruments if different than the declarant
Last name, first name for natural person/ Name of
other person
Residence address for natural person/ Residence
address (legal address) for other persons

4. Origin of cash and (or) monetary instruments

wage, income from dividends and other income from movables voluntary transfers from
business of natural person income from business and immovable realization natural or legal persons
capital participation (financial aid, grants etc.)
pension, scholarship, income from movable borrowing costs inheritance
hardship allowance, lease and land
alimony

other _____________________

5. Intended use of cash and (or) monetary instruments

current expenses investments including voluntary transfers for voluntary transfers for
(purchase of goods and purchase of immovable benefit of natural persons benefit of legal persons
services) (financial aid etc.) (charity, donations)

other _____________________

6. Transport information ( means of transport) on cash and (or) monetary instruments

Country of departure Country of destination

Date of departure Date of arrival
Transit countries
Means of transport declarant
used to enter/leave territory air rail sea road other
of the customs union

I am aware that giving false information in the

Customs declaration shall render myself liable Signature ______________________
under acting legislation of the state member of the
customs union Date «____»______________ ____

For office use only

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