FORM – F

[see regulation 8 and 19(6)(i)]

C.H.A. Licence No……….

Photo

Identity Card

M/s./Sarvashri/Shri :

Designation (Proprietor, Partner, Director, Employee) :

Issued at :

Valid upto :

Name of the Customs House Agent :

Type of CHA (Proprietorship/firm/Pvt./Public Ltd./others)

Specimen signature of the Custom House Agent :

He has passed the examination conducted under regulation 8 of the Customs House Agents Licensing Regulations, 2004.

Signature of the Deputy/Assistant Commissioner of Customs

(With seal)

(Photo to be supplied by the Agent)