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Details of applicant

Full name of individual and/or organisation who owns the object(s) being exported

Name of applicant (person signing this form)

Physical and postal address of applicant

Email address of applicant

Applicant phone (work / home)

Who will be responsible for the export of the object(s) from New Zealand?

Choose one:

Customs broker

Freight forwarder

Courier company

Applicant

Other (specify below)

Details of exporter

If the response to question above is not 'applicant', please give the name and address of the person and/or organisation who will be responsible for exporting the object(s) from New Zealand

Exporters' phone

Exporters' email