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YS LOGISTICS (S) PTE. LTD.
21 PANDAN AVENUE #05-01
SENKEE LOGISTICS HUB SINGAPORE 609388
TEL: 6466-6882 FAX: 6466-9924 Reg. No. 199004792G

DECLARATION OF FACTS
I hereby provide the following information in support of my application for Goods and Services Tax Relief on my usedhousehold articles and personal effects under Items 8 of the Goods & Services Tax (Import Relief) Order 1994 :a)

I am changing my place of residence from __JAPAN_______ (country 出国国) to Singapore.

b) I am the owner of the articles and effects imported and these have been in my possession and use for a period of notless than three months.
The articles and effects are imported within 6 months of my first arrival __01/04/2017入国日) in Singapore.

d)

I am aware that the GST relief I am applying does not cover any motor vehicle, liquors and tobacco.

e)

The customs duty and GST on the following motor vehicle included in the consignment will be paid by me before I
take :
Motor Vehicle (車両類): _NIL________________________________________________________f)

The customs duty and GST on the following liquors/tobacco included in the consignment will be paid by me after
unstuffing on the container or at the checkpoint at the time of clearance of the convectional cargo :Liquor （お酒）Tobacco （タバコ）::(NIL is required if there is none

_SAKE 750ml X2 Bottle(ある場合)_NIL______________________/(dateシンガポールc)

NIL(無い場合 )貨物に入っていない場合は“NIL”とご記入下さい)

I affirm that the information give above is true and correct.
I also undertake not to dispose of the used household articles and personal effects within three months form the dateof importation.

山種 太郎
SIGNATURE（サイン）Taro Yamatane
TG123XXXX
NAME OF DECLARANT （名前）PASSPORT NO.

MANAGEROCCUPATION （役職）

Yamatane Co.,Ltd.
01/04/2017
NAME OF EMPLOYER （会社名）DATE （日付）

（パスポート番号）…………………………………………………………………………………………………………
FOR OFFICIAL USE
Name of Forwarding Agent
CCC Permit No.
Container No.

: CROWN LINE PTE LTD: ____________________: ____________________

『ご記入サンプル』
No.2

Date

（日付） : 01/04/2017

Name（名前）：Taro Yamatane

Office Address（勤務先住所）：11XX Road #12-34 XX Tower Singapore 123456

Delivery Address（配達先住所）：21XSX Street #56-18 XX Residence Singapore 987654

Tel (O)勤務先 : 1234-5678 Tel (H)自宅 :9876-5432 Email :xxoo12@xxx.com
Dear Sir/ Madam,
Please confirm the following article in your shipment for customs declaration purpose : -1) any liquor / tobacco (dutiable)

酒・タバコ※ある場合は「YES」へ

YESNO()( X )2) any vehicle / motorbike (dutiable)

車・バイク

()

( X )

3) any weapons / pistol-shaped toys

武器/武器系のおもちゃ()

( X )

ポルノ()

( X )

新品の家具

()

( X )

トランシーバー()( X )7) any video tapes (all tapes are subjected to censorshipboard’s approval before being released ビデオ・映像類()( X )※リスト要4) any pornographic materials5) any brand new furniture6) any walkie-talkie

8) any books, cassette tapes, records and magazines(Banned books & magazines, for eg : Playboy, Penthouse or Satanic Verses will be confiscated if
discovered by customs.猥褻な本・カセットテープ・雑誌()(X )ゲームソフト()( X )※リスト要

鍵の掛かったカバン()

(X )

()

(X )

9) any computer game software cassette10)any locked suitcase / trunks(For our office reference)11)any piano-Baby grand/Upright/Grand ピアノ(for our office reference)※電子ピアノ含みません。
REMARKS

Duty-exemption is only granted for USED house removals for not less than 3 months.
The above questionnaire has been declared to the best of my knowledge. I will fully Indemnity Crown Line Pte Ltd andits staff from any fines / composition owing to the delay caused by the incorrect declaration I have made. (Under items 20of Par. 1) Customs Duties Exemption Order 1987.
All responsibilities arising (if any) will be borne by me.
Other information :山種 太郎
SIGNATURE
SAME AS ON PASSPORT（パスポートと同じサイン）