Eswatini Revenue Service

Customs and Excise Department

SURNAME

FIRST NAME

TELEPHONE

CELLPHONE

EMAIL :

COMPANY :

ADDRESS

TELEPHONE:

EMAIL:

NATURE OF BUSINESS

Type of Business

Registration Number:

Purpose of Application

Type of Application

Customs Client Number(if currently registered):

License being applied for

Type of License

CONTRAVENTION AND OTHER MATTERS

Please indicate whether during the preceding five years, the business entity(Check if Yes or leave unchecked if No)

a) Has contravened or failed to comply with the provision of the Act
b) Has failed to comply with any condition, obligation or other requirement imposed by the Commissioner
c) Has been convicted of any offence under the Act
d) Has been convicted of any offence involving dishonesty
e) Has made any false or misleading statement in any material respect or omitted to state any material fact which was required to be stated in any application for registration or for any other purpose under the Act
f) Has ever been insolvent or in liquidation.

ATTACHMENTS

RESOLUTION BY BOARD OF DIRECTORS
EMPLOYEE CV
ASYCUDA USER VERIFICATION FORM
SUPPORTING DOCUMENTS

DECLARATION

I , in my capacity as

Declare that the particulars in the application and all enclosed are true and correct, and
Undertake to:

Inform the Eswatini Revenue Service immediately of any changes in the particulars furnished in this application.
Comply with such customs and excise laws.