Authorization

…………………………
(place and date of issue)
AUTHORIZATION
To act as the representative
Hereby we authorize the customs agency:
“MA-AN” MALWINA WOLSKA, ANDRZEJ KACZOROWSKI S.C.
ul. ŚW. TERESY OD DZIECIĄTKA JEZUS 102, 91-341 ŁÓDŹ
ODDZIAŁ W GDYNI UL. WIŚNIEWSKIEGO 31/119, 81-127 GDYNIA
REGON: 473070439, NIP: PL947-18-88-515
To undertake on behalf of:
…………………………….
(name and registered office of the company giving this very authorization)
The following activities within the foreign trade:
1. To inspect the goods and their samples prior to the customs declaration.
2. To prepare all the necessary documents for the customs declaration.
3. To pay the customs duties, taxes and fees in import.
4. To pick up the goods after customs release.
5. To guarantee the amount which are the customs debts pending on the shipment.
6. To act in the customs office with all the necessary appeals or other acts needed for customs
clearance.
Hereby we accept to pass this very authorization according to art. 77 of Customs Law and we put
under our obligation:
- To inform within 14 days about any change in the status of the registration of our company, if
any.
- To give all the necessary documents needed for a correct and effective customs clearance or
other documents, if requested.
We hereby state that all the data mentioned here are truly and correct according to art. 233 of Criminal
Law.
This authorization is: (to be chosen)
- Permanent
- Temporary till….
- Single one
Confirmation of the acceptance:
………………………………
………………………………………..
(date, signature of the customs agent)
(signature and stamp)
______________________________________________________________
Contact data:
Bank:…….
Account number:…………….
Person in charge for customs’ matters:……………..
Telephone/fax:………….
Value Added Tax Identification Number:………………………..