| I affirm that the information given above is true and correct. I undertake to pay customs duty and GST on the liquors, tobacco and motor vehicle included in my consignment, and also not to dispose of used household articles and personal effects within three months from the date of importation.  SIGNATURE:_________________________________________________________   NAME OF CLAIMANT:__________________________________________________   PASSPORT NO.:______________________________________________________   DATE: _____________________________________________________________   OCCUPATION: ______________________________________________________  NAME OF EMPLOYER: _________________________________________________
 
 
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