Zcs Form 11b -

__________________ Name: ______________________ Designation: ________________ (e.g., Proprietor / Authorised Signatory / Customs Broker) Place: ______________________ Date: _______________________

Received by: _______________ Date: _____________________ Action Taken: _______________ zcs form 11b

You should adjust the bracketed [ ] sections to match your specific case. zcs form 11b