Diplomatic Goods Customs Clearance Authorization

Date:

To Whom It May Concern,

I, the undersigned authorized representative of

hereby authorize the customs clearance of the following diplomatic goods:

Description of Goods:

Quantity:

Value:

Consignee Name:

Consignee Address:

Authorized Customs Broker/Agent:

Passport/ID Number:

Special Instructions (if any):

Signature & Official Stamp

Name & Position