Approved by Resolution of the Board of the Eurasian Economic Commission No. 124 dated July 23, 2019	
			
PASSENGER CUSTOMS DECLARATION
To be filled in by a person who has attained the age of 16.
To answer affirmatively the Customs applicant shall tick the appropriate box with a sign "x" or "v".
The copy of filled in Declaration shall be kept for the entire period of temporary stay in Customs territory (outside of it) and submitted to the Customs authorities at return.	

1. The information on the Customs applicant:

ANDERSON	ALFRED		
(surname)	(name)	(patronymic (if any))	
BRITISH PASSPORT № 999072796, ISSUED ON 04.07.2024	
(Identity document (type, country of issue, series, number, issue date))	
UNITED KINGDOM, NORWICH, 15 WINDSOR STREET	
(The address of permanent residence (or registration) (to be filled in on importation of the vehicle (including temporary), importation and exportation of 	
money in cash and/or monetary instruments, and transit)	
REPUBLIC OF BELARUS, BREST, 21 MASHEROVA STREET	
The address of temporary residence (or stay) in EAEU Member State (to be filled in by a foreign citizen on importation of the vehicle (including 	
temporary), importation and exportation of money in cash and/or monetary instruments, and transit)	

UNITED KINGDOM	
REPUBLIC OF BELARUS	

(the country of departure)	
(the country of destination)	

I am followed by persons under the age of 16 in the amount of ______ person(s).

The following goods and vehicles are moved by me (a Customs applicant), persons following with me who have not attained the age of 16, or in my address:
	
2. The information on the way of transportation of the goods and vehicles:

2.1. Accompanied baggage, including hand luggage		2.2. Unaccompanied baggage (the luggage transported separately from a person entering or leaving the country) (to be filled in by a person on the entry of Customs territory of EAEU to take into account import goods quota without payments)		2.3. Goods delivered to/sent to a person who had not entered or leaved the country		

3. The information on the goods:

Import (free circulation)		Export		Temporary export		Transit		
 
  (for goods imported with exemptions)

3.1.	Money in cash and (or) traveler cheques over $ 10,000 in equivalent (per 1 person), bills of 
credit, cheques (bank cheques), securities <*>		
3.2.	Goods imported without payment of Customs duties and taxes (import with exemptions)		
3.3.	Goods, which exceed import goods quota without payments in the cost, weight and (or) quantity		
3.4.	Cultural values		
3.5.	Civil and service weapons, its main (constituent) parts and ammunition		
3.6.	Narcotic drugs, psychotropic substances, their precursors in the form of medical agents		
3.7.	Animals, plants		
3.8.	Collection materials on Mineralogy, Paleontology, bones of fossil animals		
3.9.	Samples of human biological materials		
3.10.	Other goods in respect of which prohibitions and restrictions are applied and the submission of supporting documents and (or) information is required		

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<*> It is necessary to fill in the Annex to the Passenger Customs Declaration.

4. Additional information on the goods, including those specified in columns 3.2-3.10:

№
	The name and description of the goods (identification number and other distinctive features), the type, date and number of the document confirming compliance with the conditions of import with exemption from Customs duties, taxes, and (or) the document confirming compliance with restrictions, as well as the names of the authorities that issued such documents	Weight (including primary packing of the goods that are actually being moved) (kg)/ quantity (litres, pieces)	Cost (in the currency of the EAEU Member State, euros or US dollars)	

				

				

				

				

5. Information on the vehicles:

Import (free circulation)		Temporary
admission		Export		Temporary export		Transit		
Vehicles imported with exemption from Customs duties and taxes (import with exemptions)
		
Auto- and motorvehicle		Trailer		

KIA, RIO		GBR5178, UK		U5YPC811DDL270633		1396	
(make, model)		(registration number,
 country of registration)		(identification number)  
15.02.2019		(engine capacity (sm3))
5000 	
(body number)		(chassis number)		(production date)		(cost)	
Vessel
(type)		(registration number,
 country of registration)		(cost)		(weight(kg))		(hull length (m))	

Aircraft
(type)		(registration number,
 country of registration)		(cost)		(empty and equipped weight of the aircraft) (kg))	

Part of the vehicle, replaced in a State that is not an EAEU Member State, and which is subject to accounting (registration)                                                                                                                                                                   .
(name, number)	
I am aware that the submission of false, inaccurate or incomplete information in Passenger Customs Declaration entails responsibility in accordance with the legislation of the EAEU Member State.
17.02.2026          ANDERSON
(date)		(signature)		(name, surname and patronymic (if any) of a person, acting by or on behalf of the Customs applicant, 
the details of the document)	
For official notes only:		

L.S.