Company Stamp/ /Place Date

Załącznik nr1a do PJ Nr 1/CDZ

………………………. …………………………………………, ……......

/company stamp/ /place//date/

Power of Attorney

To act as an: indirect (for the use of simplified procedures) anddirect representative

We hereby authorise: DHL Global Forwarding Sp. z o. o.

ul. 17 Stycznia 45 B,

02-146 Warszawa

Regon 470527186, NIP PL728-025-72-92, EORI PL728025729200000,AEO PLAEOF 44000080001 KRS : 0000070282

To undertake for and on behalf of:

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

/name and seat of the authorising entity/

NIP: ………………………. Regon: ………………………….. EORI: ……………………..PESEL: (in the case of a private individual doing business or civil partnership) …………………………….

Contact person:......

Telephon/Fax: ......

E-mail address to customs massages : ......

…………………………………………………………………………………………………………………………E-mail address to debit notes:………………………………………………………………………………………….

The following tasks pertaining to international trade:

Examine the goods and take samples before to entering the same for customs clearance.
Prepare the required documents and enter the goods for customs clearance.
Pay the customs duties and other fees.
Collect the goods after their release from the customs.
Provide customs bond for the sum of custom debt.
Make appeals and other requests to be reviewed by customs authorities.
Act on our behalf in customs and specific actions described in art. 138b § 2 Act of 29 August 1997, the Tax Ordinance.
Entering Intrastat declaration import/export.
Preparation, submission, signing and receipt of all documents related to the legalization of A.TR movement certificates EUR, certificates of origin and other documents, certificates, decisions, etc. Related to trade in goods on behalf of and representing the company before all state authorities and taking actions on PUESC platform.

All employed for DHL Global Forwarding Sp, z o.o. certified customs agents are entitled to act with full representation regardless of staff rotation and in line with data is passed through the Polish Customs Authority’s IT system).

Also,I hereby give my consent for this authority to be further assigned in conformity with art. 77by the Act of 19 March, 2004, Custom Law (Dz. U. Nr 68, poz. 622).

This Power of Attorney is hereby given:

a)For an unlimited period of time

b)For limited period of time by ………

c)Disposable

At the same time declare that I accept full responsibility for the accuracy of the data contained in the documents submitted to customs clearance, compliance with deadlines under the UKC, the Tax Code, the Law on VAT and service delivery to all Customs Offices of tax returns in the implementation of the deferred tax and tax liabilities resulting from the application of customs and tax procedures.

…………………………………......

/legible signature and stamp of the company authorised representative/

This Power of Attorney is accepted and confirmed by:

......

/date and signature of the company DHL GF representative)

NOTE:

The original completed and signed (by the persons authorized to represent the company) authorization, together with a legible copy of: REGON, evidence of economic activity (excerpt from the KRS, a certificate of registration in the register of business activity, the statute), and the document confirming the NIP, please provide to DHL Global Forwarding Sp. z o.o. Office:...... Submission of authorization shall be subject to stamp duty of 17 PLN. This amount will be re-invoiced for the appointer.

Security Declaration

for Authorised Economic Operators

AEO

Name (Company)
Street Adress
City
Country
Postal Code
Phone
e-Mail

I hereby declare that:

goods, which are produced, stored, forwarded or carried by order of Authorised Economic Operators (AEO), which are delivered to AEO or which are taken for delivery from AEO
are produced, stored, prepared and loaded in secure business premises and secure loading and shipping areas
are protected against unauthorized interference during production, storage, preparation, loading and transport
reliable staff are employed for the production, storage, preparation, loading and transport of these goods
business partners who are acting on my behalf are informed that they also need to ensure the supply chain security as mentioned above.

Name of Authorised Signatory[1] / Company Stamp
(where required)
Position
Signature
Date issued

This declaration was issued to:

Name (Company) / DHL Global Forwarding Sp. z o. o.
Street Adress / 17 Stycznia 45 B
City / Warszawa
Country / Poland
Postal Code / 02-146

______

Wersja:17 Obowiązuje od dnia: 01.09.2016

[1]Authorised Signatory registered at the Commercial Register