Appendix
Sample Form for meeting the Declaration Requirements of the Customs Office
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Czech Republic Import declaration | |
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Ministry of Finance Export Declaration | |
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for bank notes and coins in Czech or foreign currency, travellers cheques or money vouchers that can be cashed fot a total exceeding CZK 350,000(Act no. 61/1996 Coll. and regulation no. 224/2000 Coll.).
I. Importer/Exporter
+---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 1. Surname | | | | | | | | | | | | | | | | | | | | | | | | |
+---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 2. First Name | | | | | | | | | | | | | | | | | | | | | | | | |
+---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| | day | | | 4. Place of Birth | | | | | | | | | | | | |
| 3. Date +---+---+---+---+-------------------------------+---+---+---+---+---+---+---+---+---+---+---+---+
| of Birth | month | | | 5. Travel Document no. | | | | | | | | | | | | |
| +---+---+---+---+-------------------------------+---+---+---+---+---+---+---+---+---+---+---+---+
| | year | | | 6. Country where travel | | | | | | | | | | | | |
| | | | | Document was issued | | | | | | | | | | | | |
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 7. Address | | | | | | | | | | | | | | | | | | | | | | | | |
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
II. Owner of exported (imported money (if different from I.)
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 8. Surneme/ | | | | | | | | | | | | | | | | | | | | | | | | |
| ...... | | | | | | | | | | | | | | | | | | | | | | | | |
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 9. First | | | | | | | | | | | | | | | | | | | | | | | | |
| Name | | | | | | | | | | | | | | | | | | | | | | | | |
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| 10.Address | | | | | | | | | | | | | | | | | | | | | | | | |
+--------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
+-----------------------+-----------------------+
III. I am importing/ | Currency | Amount |
exporting | | |
+------------------------+-----------------------+-----------------------+
| Czech currency in cash | CZK | |
+------------------------+-----------------------+-----------------------+
| Foreign exchange in | | |
| cash +-----------------------+-----------------------+
| | | |
| +-----------------------+-----------------------+
| | | |
+------------------------+-----------------------+-----------------------+
| Travellers cheques or | | |
| money vouchers worth | | |
| in CZK or in foreign | | |
| currencies: | | |
| | | |
+------------------------+-----------------------+-----------------------+
Additional information concerning the purpose of import or export of the money may be, e.g. investment capital, travel expenses, etc.
+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
| | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
Advice/Guidance/Instruction
A person entering or leaving the country is obliged to declare in writing to custom's authorities the import and export of valid bank notes and coins in Czech or foreign currency, travellers, cheques or money vouchers that can be cashed for a total exceeding CZK 350,000. A legal entity importing or exporting money also has this duty. It has to declare the money through the person who is importing or exporting them. Failure to fulfil this duty can result in a fine being imposed of up to the value of the undeclared bank notes, coins, travellers cheques or moeny vouchers that can be cashed. If the custom's authorities find out that the duty to declare was not fulfilled, it can confiscate the bank notes, coins, travellers cheques or money vouchers that can be cashed, which were not declared. The custom's authority can use the same procedure if incorrect or incomplete information is given on the Form handed in by the physical or legal entity. If the imposed fine is not paid voluntarily by the due date, the custom's authority will use the confiscated bank notes, coins, travellers cheques or money vouchers that can be cashed to pay the fine.
I declare that the information I have given is true and complete, which I confirm with my signature:
Date: Signature: Personal date stamp of the customs officer:
Obrázek - Vzor tiskopisu v ruském jazyce
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