Customs Brokers Licensing Regulation 2018

FORM - G
[see sub-regulation (5) of regulation 13]

Valid up to………..

Shri/Ms. …………………. of ………………. having been registered in the books of this office as an authorized employee of Shri/Sarvashri/Ms./ M/s …………………. of …………………. having been authorized by him/them to transact business at the …………………. Custom House on his/their behalf is hereby permitted to do so for a period of …………………. years with effect from
…………………. or until the cancellation of the license issued to his principal, whichever is earlier.

He has passed the examination conducted under sub-regulation (5) of regulation 13 of the
Customs Brokers Licensing Regulations 2018.
Specimen Signature of employee: …………………….
Permanent Account Number (PAN) of employee: ………………….
Name of the Customs Broker: ……………………….
Customs Broker License No: ……………………….
Customs Station: …………………….

Dated the ………… 20....

Signature of the Deputy Commissioner/
Assistant Commissioner of Customs
(With seal)

(Photo to be supplied by the Customs Broker)