Application for FLEGT Licence Verification

Application for FLEGT licence verification

Please email completed form to , along withthe electronic FLEGT licence.

Alternatively, a paper copy of the form can be sent to the following address, accompanied by a paper copy of the FLEGT licence:

Office for Product Safety & Standards

PO BOX 17200

Birmingham

B2 2YT

If you are completing this form by hand please write legibly in BLOCK CAPITALS.

There is a £9.60 fee per licence submitted for verification. The Office for Product Safety & Standards will invoice importers periodicallyto collect payment.

1. Licence submitted for verification by: (please tick which applies to you)

Importer Third party/agent on behalf of importer

2. Purchase ordernumber (for invoicing purposes)

If you are the importer, and not a third party submitting the licence on their behalf, please skip to section 5.

3. The invoice for the £9.60 verification fee should be sent to:

The importer The third party/agent submitting the licence

4. Third party/agentdetails

Organisation

Named contact

TITLE Please tick

Mr Mrs Miss Ms Other (please state)

Surname
Forenames
Email address
Telephone no.
5. Importer details

Organisation

Named contact

TITLE Please tick

Mr Mrs Miss Ms Other (please state)

Surname
Forenames
Email address
Telephone no.
6. Exporter details

Organisation

ADDRESS

Country
Indonesia /

Postcode/ZIP code

7. Licence details
Licence number
Country of export / Indonesia
Licence expiry date / dd/mm/yy
Licensing issuing authority
8. Shipment details
Estimated arrival date / dd/mm/yy
Port of entry

MEANS OF TRANSPORT: Please tick

Maritime Rail Road Air Mail Multimodal

Other (please state)

9. Timber products contained in shipment

TIMBER TYPE BY HS CODE

Please enter the HS code, common name, and Latin (scientific) name for each timber product in the shipment.

If the shipment has more than eight different product types, add additional rows.

HS Code / Common name / Latin name
Product 1
Product 2
Product 3
Product 4
Product 5
Product 6
Product 7
Product 8

OVERALL QUANTITY IN SHIPMENT (total of all timber products)

Volume (m³)
Net weight (kg)
No of units

1/3