CUSTOMS DEPARTMENT – TURKS AND CAICOS ISLANDS ASYCUDA WORLD APPLICATION FOR REGISTRATION & USER AUTHORISATION FORM (To be completed in duplicate) To the Collector of Customs Pursuant to the Customs Ordinance 1995 and attendant Regulations, I hereby apply for registration as an authorised user of the ASYCUDA WORLD automated system and in this regard hereby provide the following information: Applicant Private Individual Limited Company Sole Proprietor Partnership Other Entity Carrier/Carrier’s Agent Cargo Consolidator Customs Broker Importer/Exporter Government Agency Transit Shed Owner Public Enterprise Freight Forwarder/Courier 1. COMPANIES/OTHER INSTITUTIONS/INDIVIDUALS APPLYING FOR REGISTRATION. (Including - Customs Brokers, Agents, Commercial Importers, Government Agencies, Statutory Bodies, Others, etc.) Name: ____________________________ Physical Business Address: Postal Address: Telephone: TIN# _______________________________ _______________________________________________________ _____________________________________________________________ ________________________ Fax: _______________________________ Email Address:_____________________________BUSINESS LICENCE #_____________________ (TIN# IS THE PAYEE NUMBER OR ESTABLISHMENT # FROM REVENUE CONTROL UNIT) NOTE: All companies and other entities applying for registration must provide the names of each individual who will be using the ASYCUDA WORLD system and include them in part B. (B) INDIVIDUALS (Including ALL employees of company in (A) above, who require access the system) 1. 2. Name: ________________________________ Name: Position: ________________________________ Position: _______________________________ Tel: ________________________________ Tel: _______________________________ Email: ________________________________ Email: _______________________________ _________________________________ 3. _______________________________ _______________________________ 4. Name: ________________________________ Name: Position: ________________________________ Position: _______________________________ Tel: ________________________________ Tel: Email: ________________________________ Email: ________________________________ ________________________________ ________________________________ 5. Name: _______________________________ _______________________________ 6. _________________________________ Name: ______________________________ Position: __________________________________ Position: ______________________________ Tel: __________________________________ Tel: ______________________________ Email: __________________________________ Email: ______________________________ __________________________________ ______________________________ 2 2. TECHNICAL REQUIREMENTS FOR REGISTRATION AS A USER OF ASYCUDA WORLD. I confirm that the personal computers (PCs) that will be used to access the ASYCUDA World system will comply with following minimum specifications. Process speed of at least 1.7 GHz RAM of at least 2 GB Microsoft Windows XP/Vista/Windows 7 Operating System Printer Scanner Java 1.6 Runtime Environment Installed 1.6 or latest version (update 20) Internet Connection at least 128 kbps I confirm that a qualified IT resource will be available to support the installation of the ASYCUDA World software 3. GENERAL CONDITIONS UNDER WHICH REGISTRATION WILL BE GRANTED The applicant agrees to notify the Collector of Customs within 24 hours of any changes in the following circumstances: i. Cease to employ all or any individual registered as a user nominated in this application form. ii. Change the address of your company or individual users. iii. Change the name of your company or individual users. iv. Cease to conduct business with Customs. v. You or any of your individual registered users are or become bankrupt. vi. You or any of your individual registered users are convicted of any offence punishable under the Customs laws or criminal legislation. Note: By signing this form, the applicant agrees to comply with all and every condition listed in (i) to (vi) above. 3 If approved as a registered user of ASYCUDA WORLD, the applicant and any other individual/applicant listed in this application, agrees to: I. Not provide copies of the ASYCUDA WORLD software which is provided by Customs for your exclusive use to any third Parties, whether registered or not II. Keep secure and not disclose to another person or reset the unique user identifier allocated - without the express permission of the Collector of Customs. III. Only use the unique user identifier to access the data in the system that is available to all registered users. IV. Input data to the ASYCUDA World system that pertains only to your transactions. V. Notify Customs immediately if you suspect that the security of your unique identifier has in any way been compromised. VI. Immediately notify Customs if you gain access to or otherwise receive data that does not relate to your lawful access to the system. VII. Not falsify, damage or impair any record or information stored in the system or to damage or impair any duplicate tape or disc or other medium stored in the system. VIII. Comply with any future conditions which may be imposed by the Collector of Customs in relation to the security of the unique identifier allocated to you or persons listed in the application or to any other matters related to the access to and use of the system. IX. Any request for the resetting of your password must be submitted to the Customs Department using your registered email account or in person at the Customs Headquarters using proper ID. Note: By signing this application form, the applicant agrees to comply with all and every condition listed in (i) to (ix) above. 4 PLEASE READ CAREFULLY THE NOTES BELOW BEFORE YOU SIGN THIS APPLICATION 1. ALL sections of this application form must be completed and all questions answered. 2. If the applicant is a company, this form must be signed by the General Manager or other authorized senior executive and the official company stamp/seal appended. 3. Regardless of individual responsibilities, the person signing this form on behalf of a company shall also be responsible for the requirements/conditions set out for each individual listed in this application. 4. By signing this form the applicant agrees to all requirements and conditions set out in this form and any other reasonable conditions that may be imposed by the Collector of Customs in respect of the registration. …………………………………………. ………………………………………………….. Applicant’s Name Signature / Date Company Seal (If applicable) ………………………………………….. ………………………………………… …………………………… Collector Registered No. Date Approved: 5