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    Customs Broker Firm Application

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    bigjoey51

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    © All Rights Reserved
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    Customs Broker Firm Application

    Uploaded by

    bigjoey51
    4 views1 page

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views1 page

    Customs Broker Firm Application

    Uploaded by

    bigjoey51

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    OPRS Form 4-2019

    Office of Professional Responsibility Section


    APPLICATION FOR CUSTOM BROKER FIRM LICENSE
    Applicant #
    Important things you need to know and do before you file this form:
     Provide Business Registration
     You must obtain a Tax Identification Number (TIN) before completing this form
     Must provide current tax Clarence
     Read the Customs Broker Licensing and Administrative Regulation
     The license fee is $100.00 USD and is non-refundable
     Meet other requirements

    Part 1: Tell Us About Yourself


    1 Business Name

    2 Date of Establishment
    3 Tax Identification Number

    5 Business Address
    Street Community City

    House # County Country

    6 Contact Info Phone Number:

    Email Address:

    PART 2: CERTIFICATION
    (Warning: Any misstatement of pertinent facts in this application constitutes sufficient grounds for denial of the application.)
    I, , on behalf of the applying institution, Certify that the statements contained in the foregoing application and
    supporting attachments thereto are true and correct to the best of my knowledge and belief. Written notice of any change in the business
    address, or any other information contained in this application, will be given to the Office of Professional Responsibility Section of the Liberia
    Revenue Authority.

    Date:
    Company Name Company Stamp / Seal

    Authorized Representative

    Authorized Signature

    The principal purpose for collecting the information is to enable the LRA determine whether the applicant meets the Minimum criteria established for
    the Customs Brokers Licensing. The information collected and contained in the applicant’s file, may be provided to those employees of the LRA,
    National Port Authority, and etc. who have need for the records in the performance of their duties.
    Disclosure of the requested information including the TIN is mandatory. They will be used as identifiers and to conduct background investigation. The
    information may be released to the public and posted by appropriate electronic means.

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