Perishable Goods Customs Clearance Authorization

Date:

Authorizing Party Details

Company/Individual Name:
Address:
Contact Number:
Email:

Consignee Details

Name:
Address:
Contact Number:
Email:

Shipment Information

Description of Goods:
Port of Arrival:
Arrival Date:
Bill of Lading / AWB No.:
Container / Package No.:

Authorized Customs Broker/Agent

Name:
Agency/Company:
Contact Number:
Email:
I/We hereby authorize the above-mentioned agent/broker to clear the perishable goods described above on my/our behalf for customs purposes.
Authorizing Party Signature & Name
Date:
Agent/Broker Signature & Name
Date: