21. DECLARATION I/We (Importer or Remitter) hereby declare(s) that the foreign currency sent abroad has corresponding prescribed documents availed by myself to the indicated local commercial bank. For goods importation, I /we attest that relevant Acquittal documents (e.g. Customs Clearance Documents) will be availed to the local commercial bank indicated above within one hundred and twenty (120) days from the date of remittance. I do hereby declare that the information given above is true and correct to the best of my knowledge and belief. Signature …………………………………………………………………………………………………… Date and Place of Signature Date: Place: Name of Authorised Signatory Official Use Only Financial Service Provider Zambia Revenue Authority 22. Date Application 29. Date Application Received Received 23. Received By 30. Name of ZRA official (Name) 24. Any Overdue Yes 31. Imported Yes Acquitals Goods verified to No match No State details on value of Form Goods 25. Application Yes 32. Relevant Yes Checked for Taxes Paid in No Correctness and Full No State Completeness Amount 33. ZRA Entry Number 34. ZRA Payment Receipt Number 26. Signature ………………………………………………. 35. Signature…………………………………………… 27. Date ………………………………………………….. 36. Date ……………………………… 28. Stamp of Commercial Bank 37. Stamp of Zambia Revenue Authority
21. DECLARATION I/We (Importer or Remitter) hereby declare(s) that the foreign currency sent abroad has corresponding prescribed documents availed by myself to the indicated local commercial bank. For goods importation, I /we attest that relevant Acquittal documents (e.g. Customs Clearance Documents) will be availed to the local commercial bank indicated above within one hundred and twenty (120) days from the date of remittance. I do hereby declare that the information given above is true and correct to the best of my knowledge and belief. Signature …………………………………………………………………………………………………… Date and Place of Signature Date: Place: Name of Authorised Signatory Official Use Only Financial Service Provider Zambia Revenue Authority 22. Date Application Received 29. Date Application Received 23. Received By (Name) 30. Name of ZRA official 24. Any Overdue Acquitals Yes 31. Imported Goods verified to match details on Form Yes No No State value of Goods 25. Application Checked for Correctness and Completeness Yes 32. Relevant Taxes Paid in Full Yes No No State Amount 26. Signature ………………………………………………. 33. ZRA Entry Number 34. ZRA Payment Receipt Number 35. Signature…………………………………………… 27. Date ………………………………………………….. 36. Date ……………………………… 28. Stamp of Commercial Bank 37. Stamp of Zambia Revenue Authority
form2_1.docx