Division (5) Box E: Request by the customs office of re-import

Indicate the content of the request as follows:

1. (a)

   verification of the authenticity of this Information sheet and the correctness of the information therein,

2. (b)

   other information to be supplied (to be detailed).

Indicate the following:

1. (a)

   full name and address of the customs office of re-import,

2. (b)

   date, place and signature.