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Blatt 1 für das Hauptzollamt

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

Validation by customs office

Anyone carrying cash/funds with a value of 10,000 Euros or more is required to fill in this declaration completely and correctly.
Please read the notesbefore beginning to fill in the form; place a cross X or fill in as appropriate. 1. Personal information a) Surname: Sex: name at birth, if applicable: first name(s): b) Address: Country Street and house number Town and postal code c) Date of birth: Day Month d) Place of birth: e) Nationality: f) Type of ID-Document: g) Number of ID-Document: h) Issuing office: i) Date of issue: 2. Itinerary EnteringEU Leaving EU ID-Card male female
Official stamp Signature

Year

other ID-Document eg. temporary passport

Passport

Date entering or leaving the EU: Country of departure: 3. Means of transport

Day

Month Country of destination:

Year via:

By air – state flight number or registration number of the aircraft: By road – state vehicle and official registration number and countrycode: - Vehicle is registered in the name of the declarant: - 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) to be declared in a separateline. 1 2 3 4 Total sum of funds in Euros: Amount/Value Amount Currency Each currency to be entered in a separate line Equivalent in Euros yes no

0401/1 Anmeldung von Barmitteln - englisch (2008) 200208

Blatt 1 für das Hauptzollamt

5.

Owner of cash/funds Declarant Other person a) Surname: name at birth, if applicable: first name(s): b) Country c) Street and house number d) Town andpostal code Company a) Name of company: b) Registered office: Country: Street and house number: Town and postal code: Sex: male female

Validation by customs office Official stamp

6.

Recipient of cash/funds Declarant Other person a) Surname: name at birth, if applicable: first name(s): b) Country c) Street and house number d) Town and postal code Company a) Name of company: b) Registeredoffice: Country: Street and house number: Town and postal code: Provenance of cash/funds (coherent, comprehensible explanation - in brief) The cash/funds originate from: Sex: male female

7.

8.

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. Iam 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 result in a substantial fine and in the confiscation of the cash/funds. The declaration is correct………………………………….. Signature of declarant

........................., ........................ Place Date

0401/2 Anmeldung von Barmitteln - englisch (2008) 200208

Blatt 2 für den Anmelder

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

Validation by customsoffice

Anyone carrying cash/funds with a value of 10,000 Euros or more is required to fill in this declaration completely and correctly.
Please read the notes before beginning to fill in the form; place a cross X or fill in as appropriate. 1. Personal information a) Surname: Sex: name at birth, if applicable: first name(s): b) Address: Country Street and house number Town and postal code c)...
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