Declaration Form for Yachts - Customs and Excise

MONTSERRATCUSTOMS AND EXCISE DEPARTMENTDeclaration For Yachts(Arrival/Departure)Rotation No.Port of …………………………………………………………………………………………………………………….………….Name of Yacht ……………………………….Gross Reg. Tonn. …………...……. Net Reg. Tonn …………………………….Owner ………………………………………………………………. Phone ………………………………………….……………Address ………………………………………………………………………………………………………………………………Country of Registry …………………………………………….. Registration No. ………………………………………………Dimensions: Length ………………………. Beam ………..…………………… Draught ………..…………………………….Last Port ………….………C’try …… ….Length of Stay ………..….. Next Port …...…………..C’try………………………..Date of Arrival. ….…/ ….../ ……. Time …… …Dur. of Voyage ………. Date of Departure ….../..…/..…. Time………….…Purpose of Visit ………………………. Type of Vessel ……………………………… # of Masts ………………………………Year Built ……………..…… Construction Material …………………. Colour ……..………. GSP # …………………………Home Port …………………......………………. # Pass. Intransit ……...…… # Pass. Disembarking……………...…………...Outboard Motor ………….…….. Quantity ………..……….. Brand ……….…………………. HP …………………………...Inboard Motor ………….………. Quantity ……………….. Brand …………….……………. HP ………..…………………...Does the Master intend to discharge any of his crew at this port? ………….……… If so, how many? …………...………….CREW LIST1.2.3.4.5.6.7.Family Name Given Names Rank Nationality Place/Date of Birth Passport No.PASSENGER LIST1.2.3.4.5.6.7.Names Place of Birth Date of Birth Passport No. Place/Date of Issue

STORESSpirits -- Litres . . . . . . . . . . . . . . . . . . . . For Official Use onlyWines – Litres . . . . . . . . . . . . . . . . . . . . . . . Entered . . . . . . . . . . . . . . . . . . . . . . . . . . .Cigarettes – No. . . . . . . . . . . . . . . . . . . . . .. Cleared . .. . . . . . . . . . . . . . . . . . . . . . . . .Tobacco – Grams . . . . . . . . . . . . . . . . . . .. . No. of Seals . . . . . . . . . . . . . . . . . . . . . . .Firearms – No. . . . . . . . . . . . . . . . . . . . . .. . Documents attached . . . . . . . . . . . . . . . .Ammunition – No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . .Other Items . . . . . . . . . . . . . . . . . . . . . . . .LIVESTOCKPermission granted to proceed toDogs – No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Cats – No. . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other – No. . . . . . . . . . . . . .. . . . .. . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . … . .. . . . . .. . . ..I certify the above to be true. I also undertake not to hire, pledge, give away, exchange,sell or otherwise dispose of this vessel in Montserrat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Signature of MasterCustoms Boarding OfficerFor Comptroller of Customs and ExciseN.B(a) If remaining over 72 hours, a Customs clearance must be obtained by theMaster before departure re.(b) This form must be retained on board to be produced to the proper officer ofCustoms and Excise on request.(c) No day tours, cruises or charters are permitted in the territorial waters Montserratexcept with passengers which are on board at the time of arrival.This form must be completed in triplicate. One copy is to be retained on board andproduced to any Customs or Police officer on request.