Form A.

Application Form for grant of custom house agents licence under section 146 of the custom Act
1962
1. Name of the applicant. (In case the applicant is a firm or a company, the name of each of the partners
of the firm or the directors of the company as the case may be).
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2. Full address of the applicant. (In case the applicant is a firm or a company the full address of each of
the partners of the firm or the directors of the company as the case may be).
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3. In case the applicant is a firm or a company, the name (s) of its partner/partners or director/directors
or duly authorised employees who will actually be enaed in the wor! as "ustom #ouse $ents.
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%. In case it is desired to appoint cler! (s) the name and address of the cler! (s).
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&. 'ducational (ualifications of each of the persons, who will actually be enaed in the wor! as "ustom
#ouse $ent.
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). *articulars reardin !nowlede of 'nlish and local lanuae and #indi. (+hese particulars are re(uired
in respect of each of the persons actually enaed in the wor! as "ustom #ouse $ent).
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,. *articulars reardin !nowlede of "ustoms -aw and procedure. (+hese particulars are re(uired in
respect of each of the persons actually enaed in the wor! as "ustom #ouse $ent).
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.. /hether the applicant had earlier applied for a licence to act as a "ustom .#ouse $ent and whether
such application was re0ected.
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1. /hether he or the firm or company by whom he is employed ha2e earlier held a "ustom #ouse $ent3s
-icence under these reulations and whether it was cancelled or suspended.
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14. /hether the applicant or any of the persons proposed to be employed by him, ha2e been penalised,
con2icted or prosecuted under any of the pro2isions of the "ustoms $ct, 11)2 or any other law for the
time bein in force.
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11. Number and date of each of the documents furnished in accordance with 5eulation ).
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12. I//e hereby affirm that I/we ha2e read the "ustom #ouse $ents -icensin 5eulations, 11.% and
aree to abide by them.
6ate7
8inature of applicant(s)