Customs Act 1901Section 79 Warehouse Licence

Application Form

1. Contact Details for ApplicationName:

Mobile Number:

Postal Address:

Email Address:

Phone Number:

Designation:

2. Client name

3. Client ABN

4. Establishment (Warehouse) Name

5. Physical Site Address

6. After Hours Contact

Name:

Phone Number:

7. Head Office

8. Integrated Cargo System (ICS) Client Registration

B1015 (January 2016

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Postal Address:

Street Address:

NoYes

Have you completed the ICS Registration process using the ABN stated above? (Please Tick)

Warehouse Licence Application Form

9. Company Membership and Persons who participate in the Management or control of the Warehouse

Name:

Name:

Name:

Name:

Name:

Name:

If space is insufficient, please attach extra pages

10. Prior ExperienceDoes the applicant or any of the persons nominated in a position of management or control have any prior experience in the operation of a licensed warehouse? (Please tick)

Yes No

If space is insufficient, please attach extra pages

If yes, please provide a brief outline:

11. Description of goods

Description of Product:

Description of Product:

Description of Product:

Quantity:

Quantity:

Quantity:

What is the estimated maximum revenue liability for the goods that will be stored in the warehouse at any one time?

Will the licensee be the owner of all the goods that will be stored in the warehouse? (Please tick)

If no, please provide the name of the owner/s of the goods and respective ABN/s:

Yes No

B1015 (January 2016)

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Position:

Position:

Position:

Position:

Position:

Position:

B1015(DEC2009)

12. Warehouse Activities (please list)

1.

2.

3.

4.

5.

If space is insufficient, please attach extra pages

13. Storage of Duty Paid/Free Goods

Yes No

Do you wish to store duty paid/free goods within the area to be licensed? (Please tick)

Indicate the activities you propose to undertake should the warehouse licence be approved:

14. Duty Free ShopsAre you applying for permission to operate as duty free shop? (Please tick)

If yes, please indicate the type of duty free shop you propose to operate:

Yes No

On-Airport Inwards

On-Airport In/Out

On-Airport Outwards

Off-Airport

15. Storage of excisable goods

Will you be storing excisable goods? (Please tick)

Yes No

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Yes No

If yes, please indicate if you have the required licence/s granted by the Australian Taxation Office (ATO):

If you wish to store excisable goods or use imported EEGs in the manufacture of excisable goods and you are not applying for a licence as a Catering Bond, Providore or Duty Free Shop, you will need to contact the ATO directly.

Warehouse Licence Application FormB1015 (January 2016)

16. Additional Information for Providores and Catering Bonds

Will you be selling alcohol and/or tobacc as ships store?

What is the quantity of product you expect to receive each year?

Name:

What companies will supply EEG goods to the warehouse?Yes No

ABN:

Name: ABN:

Quantity:Description:

Quantity:Description:

17. Quality Management System

Yes No

Do you have a certified Quality Management System? (Please tick)

If yes, please indicate what standard you are using:

18. Standard Operating Procedures (SOPSs)

Yes No

Do you have documented SOPs in place that are made available upon request by the Department of Immigration and Border Protection? (Please tick)

Attachments - Tick when you have attached the required document

Constitutional Documents

Management and Control

Company Extract

Corporate Membership Structure

Related Companies

Financial Information

Warehouse Site Plans

Physical Separation and Construction of Premises

Physical Security of the premises19.

20.

21.

22.

23.

24.

25.

26.

Examination Equipment

Financial Security

Warehousing Procedures and Recording Systems

Asbestos Report

Duty Free Shops

Ownership/Lease Vertification

27.

32.

31.

30.

29.

28.

33.

34.

Insurance

I hereby declare that I have supplied all information in the application form and attachments as detailed above.

I also declare that all information provided above and relevant attachments in relation to this section 79 warehouse licence application are true and correct.

Signature:

Date:

Name:

B1015 (January 2016)

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