Blatt 1 für das Hauptzollamt

Declaration of Cash/Funds
Pursuant to Regulation (EC) 1889/2005of the European Parliament and of theCouncilof October 26th, 2005
(Official Journal L 309, 25.11.2005, p. 9)

Validation by customs officeAnyone carrying cash/funds with a value of 10,000 Eurosor more is required to fill in this declaration completelyand correctly.
Please read the notes before beginning to fill in the form; place across  or fill in as appropriate.
1. Personal information

Official stampa) Surname:Sex:
malefemale
name at birth, if applicable:
forname(s):b) Address: Country
Street and house number
Town and postal codec) Date of birth: _ _ Day _ _ Month _ _ _ _ Yeard) Place of birth:e) Nationality:f) Type of ID-Document: ID-Cardother ID-Document eg. temporary passportg) Number of ID-Document: _____________________________________h) Issuing office:i) Date of issue:
2.

Itinerary
Entering EU

Passport

Leaving EU

Date entering or leaving the EU: _ _ Day _ _ Month _ _ _ _ YearCountry of departure:
Country of destination:
3.

Signaturevia:

Means of transport
By air – state flight number or registration number of the aircraft:
By road – state vehicle and official registration number and country code:- Vehicle is registered in the name of the declarant:

yesno- Type of vehicle (e.g. car, van, bus):
By rail – state train type and train number:
By sea – state shipping line and company:- Registration number of private boat:
4.

Amount and type of funds
Each type of fund (e.g. banknotes, coins,traveller`s cheques, cheques to order,
shares, debentures, promissory notes) tobe declared in a separate line.

AmountAmount/ValueCurrency
Each currency to be entered in a separate line

Total sum of funds in Euros:
XXXX Anmeldung von Barmitteln – englisch (2007)190407

Equivalentin Euros

Blatt 1 für das Hauptzollamt

5.

Validation by customs office

Owner of cash/funds
Declarant
Other person

Sex:malefemalea) Surname:name at birth, if applicable:
forname(s):b) Countryc) Street and house numberd) Town and postal code

Official stamp

SignatureCompanya) Name of company:b) Registered office: Country:
Street and house number:
Town and postal code:
6.

Recipient of cash/funds
Declarant
Other person

Sex:malefemalea) Surname:name at birth, if applicable:
forname(s):b) Countryc) Street and house numberd) Town and postal code
Companya) Name of company:

7.

8.

b) Registered office: Country:
Street and house number:
Town and postal code:
Provenance of cash/funds (coherent, comprehensible explanation – in brief)
The cash/funds originate from:

Intended use of cash/funds (coherent, comprehensible explanation – in brief)
The cash/funds are to be used for:I hereby confirm that I have read and understood this declaration in its entirety.
I am aware that the given information may be checked for its correctness and completeness.
The obligation to render declaration will be deemed non-fulfilled in the event that the information is incorrect or incomplete. Violation of the obligation to render a declaration constitutes an offence and can resultin a substantial fine and in the confiscation of the cash/funds.
The declaration is correct........................., ........................

…………………………………..

Place
Date
Signature of declarant
XXXX Anmeldung von Barmitteln – englisch (2007)190407

Blatt 2 für den Anmelder

Declaration of Cash/Funds
Pursuant to Regulation (EC) 1889/2005of the European Parliament and of theCouncilof October 26th, 2005
(Official Journal L 309, 25.11.2005, p. 9)

Validation by customs officeAnyone carrying cash/funds with a value of 10,000 Eurosor more is required to fill in this declaration completelyand correctly.
Please read the notes before beginning to fill in the form; place across  or fill in as appropriate.
1. Personal information

Official stampa) Surname:Sex:
malefemale
name at birth, if applicable:
forname(s):b) Address: Country
Street and house number
Town and postal codec) Date of birth: _ _ Day _ _ Month _ _ _ _ Yeard) Place of birth:e) Nationality:f) Type of ID-Document: ID-Cardother ID-Document eg. temporary passportg) Number of ID-Document: _______________________________h) Issuing office:i) Date of issue:
2.

Itinerary
Entering EU

Passport

Leaving EU

Date entering or leaving the EU: _ _ Day _ _ Month _ _ _ _ YearCountry of departure:
Country of destination:
3.

Signaturevia:

Means of transport
By air – state flight number or registration number of the aircraft:
By road – state vehicle and official registration number and country code:- Vehicle is registered in the name of the declarant:
Blatt 2 für den Anmelder

yes

no- Type of vehicle (e.g. car, van, bus):

By rail – state train type and train number:
By sea – state shipping line and company:- Registration number of private boat:
4.

Amount and type of funds
Each type of fund (e.g. banknotes, coins,traveller`s cheques, cheques to order,shares, debentures, promissory notes) tobe declared in a separate line.

AmountAmount/valueCurrency
Each currency to be entered in a separate line

Total sum of funds in Euros:
XXXX Anmeldung von Barmitteln – englisch (2007)190407

Equivalentin Euros

Blatt 2 für den Anmelder

5.

Validation by customs office

Owner of cash/funds
Declarant
Other person

Sex:malefemalea) Surname:name at birth, if applicable:
forname(s):b) Countryc) Street and house numberd) Town and postal code

Official stampSignatureCompanya) Name of company:b) Registered office: Country:
Street and house number:
Town and postal code:

6.

Recipient of cash/funds
Declarant
Other person

Sex:malefemalea) Surname:name at birth, if applicable:
forname(s):b) Countryc) Street and house numberd) Town and postal code
Companya) Name of company:

7.

8.

b) Registered office: Country:
Street and house number:
Town and postal code:
Provenance of cash/funds (coherent, comprehensible explanation – in brief)
The cash/funds originate from:

Intended use of cash/funds (coherent, comprehensible explanation – in brief)
The cash/funds are to be used for:I hereby confirm that I have read and understood this declaration in its entirety.
I am aware that the given information may be checked for its correctness and completeness.
The obligation to render declaration will be deemed non-fulfilled in the event that the information is incorrect or incomplete. Violation of the obligation to render a declaration constitutes an offence and can resultin a substantial fine and in the confiscation of the cash/funds.
The declaration is correct........................., ........................

…………………………………..

XXXX Anmeldung von Barmitteln – englisch (2007)190407

PlaceDate

Signature of declarant

For your information:
Any individual entering or leaving the EU and carrying cash/funds of a value of 10,000 Euros or more is required to declare that sum to thecompetent authorities.
Funds located in hand luggage, checked-in luggage and means of transport shall be deemed to be carried by an individual.
Funds are defined as:•Cash
All notes and coins in circulation as legal tender, whether in Euros or another currency•

Transferable bearer securities including instruments of payment with a bearer clause,
e.g. traveler`s cheques, bearer cheques, bearer bonds, bonds of public corporations, debentures, bonds, bearershares, bearer/profit sharing certificates, interest/renewal certificates•

Other transferable securities, either bearing a bearer clause, endorsed without restriction, made out to a fictitious
recipient or in any other form effecting the transfer of legal entitlement upon handoverincluding cheques, sola bills of exchange and money orders•

Incomplete securities which are signed without stating the name of the payee
including cheques, sola bills of exchange and money orders

Anyone giving false or incomplete information will be committing an offence pursuant to Section 31 b of the Customs Administration
Law, which can result in a fine of up to 1 million Euros.
Information pursuant to Section 4 Paragraph 3 of the Federal Data Protection Act:The obligation to render a declaration derives from Article 3 of Regulation (EC) 1889/2005. The data is processed in automated procedures incompliance with the provisions of the data protection act.
Please note:
The form has a carbon copy.
To fill in page 2, please turn over.

XXXX Anmeldung von Barmitteln – englisch (2007)190407