ISSN 0856 - 034X
Supplement No. 37
09" September, 2016
SUBSIDIARY LEGISLA TION
to i/ic' (;a:e/k' of i/ic' (!IiiJt'i/ /?IL'/)lI/)/iL of ian:wiio /W). 38 Jul 97 (/(liC'(/ 09" Se/)ielflber. 2016
l>rinted by the Government l'rmter. 1)ar es Salaam by Order ol' Government
(iovHtNiINr Noiic No. 268 Published on 09/09/2016
I'HE AN]]-MONEY LAUNE)ERING AC'I', (CA P.423)
REGULA!'JONS
(Ivicick' zuuk'r .$eclion 29)
UHF AN'I'I-MONEY LAUNDERING (CROSS-130R1)ER DECLARATION OF CURRENCY AND E3FARER NEGOTIABLE INSTRUMENTS)
REGIJLA'I'IONS, 2016
ARRANGEMFN'I' OF REGULATIONS
Regulation Title
Citation Application Interpretation
PAR'I' I PRELIMINARY PROVISIONS
ilJifl-A'IOJIL'r I iiiiztIeriiH,' (( 'ross-Border I)L'cIur,Iion o/( iirreiicy (1/1(1 l3eurer
Vegoiiable IJ,sIrliiiIei,ts)
.\ ,. .?Os (c()flI(i. )
PAR'l H DI.CI .ARAII0N 01 CI.JRRINCY AND UIARlR NEG0I]AIIJ
INSIRUM FNIS
A. Prescribed amount flr declaration l)eclaration of currency and bearer negotiable instruments Compound of oHences
I'/\ir iii CLJS1'OMS OFI:ICI:RS' OIflIGATIONS
Submission of declaration forms to FlU I'owcr ol customs officer to conduct search Seizure of undeclared or fdselv declared currency or hearer negot iabk instrument s I'roh iL)it ion ui in Rrmat ion disclosure
PARF IV ('JFNIRAI. PROVISIONS
I I . Return oF sei,cd currency or bearer negotial)le instruments
/Inhj-A'Io/lei I.Ul(1/(IL'/'i!i4 (( /'os.v-13()/'(/er /)L'C'I(lI'(il!OIl o/(ztrrei,cv aiul I3ea,'r iVe,'oiia/Ie //LsirunwnIs)
(L.V..\u. 26'; (c0n1/.)
TI Il ANTI-MONkY l.AUNI)IRlNG ACT, (CA PA 23)
RF;G ULA1'IONS
(i1Jad' il/Ic/er secuion 29)
II IN ANFI-MONNY j,\I. NI)NRIN(; ((RosS-noR)NR 1)1:('I.ARANN OF ('(JIRj'N('Y AND ItL\RNR NN( a )IIAUI.N INStRtIMNNFS) RLGLJI.AFR)N.S. 2u6
PART I
PRFI.IMINARY I>ROVISIONS
('iti1ion I . These Re&ulations may be cited as the Anti-Money I .aundcring (Cross-l3order l)eclaration ol' Currency and Rearer NeL&ot iable Instruments) Rciti lations. 2016.
Application 2. Ihese Retulations shall apply to Mainland
lani.ania.
InkIpictation 3. In these Regulations unless the context requires otherwise-
(ap..123 "Act" means the Anti-Money I .aundcring Act;
"bearer negotiable instrument'' means the instruments in bearer i'oim the delivery of' which, with or without
cndorsemeiit and includes, passes title, bank drafts,
promissory notes, cheques, money orders, and travelers' cheques, bearer bonds, postal orders and
prepaid Cards;
"court" nieans any subordinate court except primary court;
"cross border transportation" means any physical
transportation of currency or bearer negotiable instrument from main land Tanzan a to another
country or vice versa and includes-
physical transportation by natural person, or in that
person's accompanying luggage or vehicle;
shipment of currency or bearer negotiable instrument
3
Anti-Money Laimc/ering R'ross-Bor(ler Declaration of Currenc p and Bearer Negoijalle Instruments)
(;......\ . .? O
through containerized cargo; or
(c) the mailing ol' currency or bearer negotiable
instrument by natural or legal person;
"currency" means a coin and printed money, local or foreign, that is designated as legal tender and circulates as, and
is customarily used and accepted as, a medium of
exchange in the country of issue;
"customs olticer" means any officer employed by the Customs
authority or any other Government of lie lal appointed
by custonis to perform duties in relation to customs at a particular exit and entry point;
"lilsc declaration" means a misrepresentation of the value of currency or hearer negotiable instninient being
transported, or m iSrepreScntat ion of other relevant
data which is required br submission in the declaration or otherwise requested by the relevant
authorities;
*l:iniiic in I Intelligence U ii it also described as Ft U" means the
Unit established under section 4 of the Act;
Cap.256 "seizure" has the meaning ascribed to it under the Proceeds of
Crimes Act.
PART II
DFCLARAI'ION 01: CURRFNCY AND BEARER NEGO'IiABLE
INSTRUM EN'l'S
!'iccrhed 4.-( I) For purposes of declaration of currency or aillotint for bearer negotiable instruments under section 23(1) of the Act, declaration
the prescribed amount shall be United States 1)olbars 10,000 or
its equivalent in Tanzanian shillings or any foreign currency based on the official conversion rate of the Rank of Tanzania which is in effect at the time of transportation of the currency
or bearer negotiable instrument across the border.
(2) For purposes of declaration, where a person has
currency and bearer negotiable instruments, the prescribed
amount for declaration shall be the aggregate of such currency
4
A176-A4017et' J.uwic/eriiig (('ros,r-lJo,vler /)eciciraiion of Currency (117(1 hearer iVegotiable 11 i.vIruiiienhs)
C. V .\'o. 268 'cv,z1/.)
and i nstrunlent.
(3) Where there is 110 official coiicrion rate of the Rank of lanzaii ia in respect of a particular currency, the exchange rate of the Central Bank or Monetary Authority that
issued the currency shall be used.
)eclaratioji ol 5.-( I) A. person shall not enter or leave the territory of currency or the United Republic while in possession of currency or bearer bearer
negotiable instrument of an amount referred to in regulation negotiable iiistrtinicnt I ) without declaring to the custoiiis authority.
(2) Any person who enters or leaves the United
Republic while in possession of currency or bearer negotiable instruments in any amount equal to or above the prescribed amount for declaration, shall:
fill in the currency or bearer negotiable instrument
declaration form prescribed in the First Schedule
and declare to customs authority such amount of money or bearer negotiable instruments; and
present the filled in form to the Customs authority
for inspection.
(3) The customs officer who receives the declaration
under sub-regulation (I) form shall retain the original
declaration form and handover a duplicate copy of the
declaration form to the person who made the declaration.
(4) The customs officer shall within twenty Ibur hours from the time, submit the relevant declaration forms to the
Customs Officer in-charge of the station. (5) Any person who contravenes the provisions of this
regulation comm its an offence and shall, on conviction, be liable to a penalty provided for under section 2813 of the Act.
Compound 01' 6.-( I ) Where a person comm its an offence under ollences regulation 5, the customs officer in charge may at any time
compound the offence by ordering the person to pay a sum of
money specified but not exceeding the amount of line prescribed fOr the offence.
ilnii-!v!oizey L,ziiulering (Cross-/iorder /)ec/aration of (_urrency unct Bearer
Ne,'oIiahIe insiruinenIs)
(L\.:Vo. 268 (c,ithi.)
(2) A custoniS oil teer may exercise powers tinder
sub-regulation (1) i
(a) the undeclared or falsely declared currency or
hearer negotiable instruments are not related to
financing of terrorism, money laundering, or any
predicate offence;
(h) the undeclared or falsely declared currency or bearer negotiable instruments does not exceed i'aiianian Shillings or any foreign currency
equivalent to 30,000 USD; or
the person concerned admits in writing that he has committed the said offence and agrees to pay the
penalty imposed.
(3) Where the Customs Officer in charge compounds
an offence under sub-regulation ( I ) he shall-
(a) satisfy himself that the offence meets the
conditions specified in sub regulation (2);
(h) record in writing, specifying the offence
committed, the sum of money to be paid and the
date for payment; and
(c) order the person to pay a penalty of tell percent of the undeclared or falsely declared currency or bearer negotiable instrument, in i'anzanian
Shillings, United States Dollars, or Euros.
(4) Where an offence is compounded under these
Regulations-
the person concerned shall not be liable for any
other penalty or charges in respect of that offence;
and the compounding decision shall be final and not subject to any appeal.
417Ii-A'1Lo/r'' ItiiiicIt'i'iiiç' (( /'()S.'-/))/(/('i• /.)cc'Ia,?lIioIi o/( lIrr(!,1Ci' .iuf IIc'circ,' !Vc'io!u ihlc' I,,.vlrui,ien(s)
(;u. 26' (,o,i/c/. )
P/\R'l Ill CUSTOMS OH:ICI:RS OBLlGATONS
Submission ui 7.-( I) Ihe Customs Officer in-charge shall report to (teciaIII1un the II tJ on every dec!aratioii made under regulat IOU 5. lorms to FlU
(2) I he report made under sub-regulation ( I ) shall: (a) be ill approved and dLIlly filled fbrm (1) coiita ii relevant in formation to the matter being
reported (c) be submitted to 1:1 U within seven working days
from the date of receipt ol the declaration form.
Power ol 8. Where it Customs off CCI suspects, on reasonable '.UStOfltS officer grounds, that a terson has contravened the provisions of these to conitict search Regulations, he may search the person or belongings of such
person.
Seizure 0' I O.-( I ) \Vhere it person has contravened the uiidceiared or provisions of' regulation 5, the Customs Officcr shall- iaisei (lecialed
currency or (a) seize the whole amount of' the undeclared or bearer Rilsely declared currency or bearer negotiable aeuot able
I list rullielits n St 1 . 111)1 Cfl ts: and
(b) issue a seizure notice to the person whose undeclared CU Irene)' or bearer negotiable
instrument is seized as provided in the Second Schedule and retai ii a copy of such not ice.
Where a Customs Officer seizes the undeclared or lIlsei)' declared currency or bearer negotiable instruments, lie shall, \vitl)in twenty four hours, deposit (lie currency seized to the special account provided to the customs authority by the l•'lu.
Where the undeclared or falsely declared currency or bearer negotiable instrument is seized in accordance with these Regulations, the Customs Officer shall investigate the matter and submit the case file to the l)ircctor of Public Prosecutions for institution olcriminal proceedings.
(1) \Vhere a persoiì is convicted for an offence committed under these Regulations, the court may issue an
7
An/i-Money Laundering (('ross-I3order DecIaraiion of('urrencv and Bearer
iVegoiiable Insiritinenis)
U. A A;. 26$ (Co/dc!.)
order for forfeiture or confiscation of the currency or bearer negotuible instrument which was seized in connection with the ofInce.
Where a court makes an order for forfeiture or confiscation in respect of currency which was seized and deposited in the Flu account, the Commissioner of FlU shall arrange for the payment to the Treasury Registrar of an amount spcci lied in the forfeiture order.
Where an order of forfeiture is in respect of a hearer negotiable instrument, the court may order for the payment of the value of money equal to the amount prescribed in the relevant bearer negotiable instrument, or For further endorsement in favour of the 1'rcasury.
Prohibition ol , I O.-( I ) A person shall not disc lose to any mIoflnation unauthorized third party any information provided in a disciosuic
declaration form submitted to him or which came to his knowledge by virtue of his employment except where the information is required by any law enforcement agency or court of law.
(2) Any person who contravenes the provisions of this regulation commits an offence and shall, on conviction, be liable to a penalty provided for under section 2813 of the Act.
PARI' IV GENERAL PROVISIONS
Return oI'seized 11. Where a currency or bearer negotiable instruments currency or is seized in accoi'dane with these Regulations, the bearer necotiahie Commissioner of FlU may return the currency or bearer instruments negotiable instruments to the person from whom the currency
or bearer negotiable instruments were seized if-
it is decided, afler investigation, that there is no need to prosecute the mattcr; 01'
there is an order of the court to that effect.
8
Anli-A4one.y Laziizcleriiig (('ross-Border Declaralio,, o/C'urrencp and Bearer Negotiable Ins(ru,nenls)
(LA•. Vo. 26 (could.)
FIRST SCHEDULE Form I
(Made under regulation 5(2)(a))
United Republic of Tanzania
Tanzania Revenue Authority
CROSS BORDER DECLARATION OF CURRENCY AND BEARER NEGOTIABLE
INSTRUMENTS
Form for Declaration of Currency and Bearer Negotiable Instruments by
Travellers Crossing Borders
Made under the Anti-Money Laundering (Cross-Border Declaration of Currency and
Bearer Negotiable Instruments) Regulations, 2016
All cash or BNI amounting to at least USD 10000 or its equivalent in any other
currency must be declared
Last Name (Surname): ..............................................
Middle Name . ..............................................
First NameS ..............................................
Gender . ..............................................
Date of Birth . ..............................................
Nationality . ..............................................
Passport No ..............................................
Occupation: ..............................................
Country of ResidenceS ..............................................
Date of Travel...............................................
Name
Currency
Code
Total
Amount
Amount
in USD
ue
C
te
;pecify):
OIAL
1. Bearer NegotiaLbL. ostruments to Declare
No Bearer Negotiat ,ic Instrument Currency
1 Cheque
2 Travelers Chec
3 Money Order
4 Bill of Exchanf
5 Promissory NC
6 Prepaid Card
7 Other (please
ililli-lt'Ioiiei' Luiiiick'riiig (C'ros.v-Iiorcler I)ecluraiion o/('zirrt'/Jcv aiicl he(rer
iVegoilable Insiruinenis)
(;....... i. 26
Direction of Travel (Entering Tanzania or Leaving Tanzania)?:
Arrival From/Going to (Final Destination)' ..............................................
Port of Entry/Exit: ..............................................
Flight/Vehicle/Vessel No' ..............................................
Currencies to Declare
No Currency Name Currency Code Total Amount Amount in USD I
1
2
3
4
5
- TOTAL
Owner of Currency and/or Bearer Negotiabe Instruments:
Intended Recipient of Currency and/or Bearer Negotiable
Instruments' ........................... ....... . ............. ................................................
Intended Use of Currencies and/or Bearer Negotiable Instruments (Tick
where appropriate)
Business Li Conference
10
AnIi-A'IonL'3' Lctiuidering (0russ-/3orc/er I)eclaraiion u/C urrency and l3earer A'egoiiable Insiruinenis)
(L.V.,Va. 26S (.ontI.)
Visit El Holiday Li Transit [I] Investment L Education t Medical
Other (Please specify):
I declare that all the information given on this form is correct and accurate.
Signature..............................................
Receiving Officer's Name:
Date . ..............................................
Signature...............................................
Anti-ivIoney Laundering ('Cross-Border Dec/oration of Currency and hearer
Neo!iab/e liustruinents)
G.N. Au. 268 (could.)
United Republic of Tanzania Form II
Tanzania Revenue Authority
CROSS BORDER DECLARATION OF CURRENCY AND BEARER NEGOTIABLE
INSTRUMENTS
Form for Declaration of Currency and Bearer Negotiable Instruments in Shipped Parcels and Cargo
Made under the Anti-Money Laundering (Cross-Border Declaration of Currency and
Bearer Negotiable Instruments) Regulations, 2016
All cash or BNI amounting to at least USD 10,000 or its equivalent in any other
currency must be declared
If the sender is an individual:
Last Name (Surname)' ..............................................
Middle Name' ..............................................
First Name' ..............................................
Gender ..............................................
Date of Birth' . ..............................................
Nationality' ..............................................
ID Name/Type' ..............................................
IDN0' ..............................................
Occupation' ..............................................
Full Address' ..............................................
Country'
If the sender is a legal person:
Company/Organisation Name'...............................................
Physical Address',..............................................
12
A,zii-tv1017e' Launclerinç' (('ross-Border Declaration oJ Currency cind Bearer Neoi'iable Inslruineiil.$)
(..\ ..\'o. 26 (collU.)
Postal Addres• .
Country . ..............................................
Name of Officer Responsible for the Parcel/Cargo:
Telephone Numbers (Landline and Mobile) ..............................................
If the recipient is an individual:
Last Name (Surname) . ..............................................
Middle Name . ..............................................
First Nami . ..............................................
Gender ..............................................
Date of BirthS ..............................................
Nationality . ..............................................
ID Name/Type . ..............................................
IDNo . ..............................................
Occupation . ..............................................
Full Address . ..............................................
Country . ..............................................
If the recipient is a legal person:
Company/Organisation Name . ..............................................
Physical Address . ..............................................
Postal Office Address . ..............................................
Country . ..............................................
Name of Officer Responsible for the Parcel/Cargo:
Telephone Numbers (Landline and Mobile) . ..............................................
Company/Organisation Name . ..............................................
Full Address . ..............................................
Telephone Numbers (Landline and Mobile) . ..............................................
Name of Officer Handling the Parcel/Cargo . ..............................................
Duty Statlon . ..............................................
Flight/Vehicle/Vessel No . ..............................................
41, Parcel/Cargo Identification Details . ..............................................
13
Au! i-Money Laundering (Cross-Border Dec/urn/ion of Currency audi Bearer
iVegoicih/e Insiruinenis)
(;v.A'u. 26 (wth/.)
PART IV - CURRENCIES AND BEARER NEGOTIABLE INSTRUMENTS TO DECLARE
No Currency Name Currency Code Total Amount Amount in USD
1.
2
3
4
5
TOTAL
43. Bearer Negotiable Instruments to Declare
No Bearer Negotiable
Instrument
Currency
Name
Currency
Code
Total
Amount
Amount
in USO
1 Cheque
2 Travelers Cheque
3 Money Order
4 Billof Exchange
5 Promissory Note
6 Prepaid Card
7 Other (please specify):
TOTAL
Intended Use of Currencies and/or Bearer Negotiable Instruments . ............
I declare that all the information given on this form is correct and accurate.
Sender/Recipient's Signature: ..............................................
Receiving Officer's Name..................................................................................
Date . ..............................................
Signature . ..............................................
14
Aiiii-A'Ioiic'i /.uiiiuferiizg (( r(),rs-/3ork'/ 1)h.laraiio,z o1C ' 1lr1 -Lilcr (1/1(1 /3t'ure,
Alegoliable 111.vlulfnlL')!Is)
26S (eø/ih/.)
SECOND SCHEDULE Liorm
(Made under regulation 10(1)(b))
United Republic of Tanzania
Tanzania Revenue Authority
CROSS BORDER DECLARATION OF CURRENCY AND BEARER NEGOTIABLE
INSTRUMENTS
.Form for Seizing Undeclared or Falsely Declared Currency and l3earer
Negotiable Instruments byIravellers
Made under the Anti-Money Laundering (Cross-Border Declaration of Currency and
Bearer Negotiable Instruments) Regulations, 2016
All cash or BNI amounting to at least USD 10,000 or its equivalent in any other
currency must be declared
21. Last Name (Surname) . ..............................................
Middle Namc................................................
First Name . ..............................................
Gender . ..............................................
Date of Birth ..............................................
Nationality . ..............................................
Passport No . ..............................................
Country of Residence . ..............................................
Physical Address in Tanzania . ..............................................
Physical Address Abroad . ..............................................
Email Address(es) . ..............................................
Telephone Numbers (Landline and Mobile) . ..............................................
Occupation ..............................................
Work/Employment Physical Address ..............................................
15
A,iii-Ivfoney Laundering Cross-Border Declaraikni ofCuirrency aiicl flearer iVegotiable Instruinenis)
G.N. .Vo. 268 (conk].)
Work Telephone Number(s)• .
Postal Address: ..............................................
Marital Status ...............................................
Name of Spouse ...............................................
Occupation of Spouse ...............................................
16
A,zti-Monej' Laundering (Cross-Border Declaration of Currency and Bearer Negotiable Insiruineni.$)
G.N. ,Vo. 268 (eo,z11.)
OTHER DETAILS IF APPLICABLE
Other NationaIities ..............................................
Other Identity Documents in Possession:
No Name/Type of ID No. First Middle Name l.ast Name issuer Date of Expiry
ID - Name (Surname) Issue Date
l•JiiIIII'1*fiI1I
Date of Travel . ..............................................
Direction of Travel (Entering Tanzania or Leaving Tanzania):
Arrival From/Goingto (Final Destination) ..............................................
Port of Entry/ExitS ..............................................
Flight/Vehicle/Vessel No ..............................................
Transit Point(s) ..............................................
Purpose of TravelS ..............................................
Other Persons Traveling with you
No
1
First
Name
Middle
Name
Last Name
(Surnamis)
Passport No. Nationality
2
3 . .
4
6
7
17
Aiiii-A'Ioiiev L(11I/1(I(!ri/Ig (C 'I?)S.V-13 r(f(r I*'c/u,tIioii (j ( 'U , P/1C1' (1/1(1 /karer
zVetoiiuh/e II/V!/!I/),CJ/fs)
20 (cocI. /
PART HI —CURRENCIES AND BEARER NEGOTIABLE INSTRUMENTS uNDEcLARED
53. Currcnces
No Currency
Name
1
2
3
4
5
Currency Code Total Amount Amount in USI)
- TOTAL
1 () 1•)
Ai,ii-i\'.Ionev, L(l1l/1(/L'r!/7g (('li),v,v-I)()IC/(.?r I)t'clariiioii ?I 1'11'L' ((11(1 /3c';rer
JVL.olulh/' insiritnien(s) -
(.,V.:\o. 26' (can/cl.)
54. Bearer Negotiable Instruments
No Bearer Negotiable
Instrument
Currency
Name
Currency
Code
Issuer
of BNI
Total
Amount
Amount in
USD -
1 Cheque
2 Travelers Cheque
3 Money Order
Promissory Note
4
5
BilIof Exchange
6 Prepaid Card
7 Other (please specify):
TOTAL
Owner of Currency and/or Bearer Negotiable Instruments
Source of Currency and/or Bearer Negotiable Instruments
Intended Recipient of Currency and/or Bearer Negotiable
Instruments . ...........................................................................................................
Intended Use of Currency and/or Bearer Negotiable lnstrumerits . ................
I declare that all the information given on this form is correct and accurate
Traveler's Signature: ..............................................
Offence Committed (Currency and/or BNI undeclared or Falsely
DecIared?) ..............................................
Receiving Officer's Name . ..................................................................................
Date and Time of Seizure . ..............................................
Officer's Signature . ..............................................
19
ilnli-!vloney Lazuideriizg Cross-13oriler i)eclarcition of (Jz,rrency and Bearer Negoiwbie Ins !rwneiiI.$)
(; \'Vo 268 (con/il.)
Form IV
United Republic of Tanzania
Tanzania Revenue Authority CROSS BORDER DECLARATION OF CURRENCY AND BEARER NEGOTIABLE
INSTRUMENTS
Form for Seizing Undeclared or Falsely Declared Currency and Bearer
I Negotiable Instruments in Spped Parcels and Cargo
Made under the Anti-Money Laundering (Cross-Border Declaration of Currency and
Bearer Negotiable Instruments) Regulations, 2016
All cash or BNI amounting to at least USD 10,000 or its equivalent in any other
currency must be declared
If the sender is an individual:
Last Name (Surname)...............................................
Middle Name ..............................................
First Name . ..............................................
Gender . ..............................................
Date of BirthS ..............................................
Nationality . ..............................................
Country of Residence ..............................................
Country Where Parcel/Cargo is Sent From . ........................................... ...
ID Name/Type ..............................................
lDNo ..............................................
Physical Address ..............................................
Postal Address . ..............................................
Telephone Numbers (Landline and Mobile) ..............................................
Email Address(es)...............................................
Occupation...............................................
Work/Employment Physical Address...............................................
20
AIzii-IvIoney I.aundering '0-oss-/3orcler Declaraiio,i of('urrency alici Bearer
Negotiable Inslri,,nen!s,.)
G.N. Ao. 268 (c',ild.)
Work Telephone Nmber(s) .
Marital Status: ..............................................
Name of Spouse'. ..............................................
Occupation of Spouse' ..............................................
If the sender is a legal person:
Company/Organisation Name. .......... ....................................
Name of Company/Organisation CEO' ..............................................
Company/Organisation CEO Telephone Numbers (Landline and Mobile):
Company/Organisation CEO Email Address(es)' ..............................................
Physical Address' ..............................................
Postal Address: ..............................................
Country' ..............................................
Name of Officer Responsible for the Parcel/Cargo:
Telephone Numbers of Officer Responsible for the Parcel/Cargo (Landline
andMobile) . ...........................................
If the recipient is an individual:
Last Name (Surname) . ..............................................
Middle Name . ..............................................
First Name . ..............................................
Gender ..............................................
Date of Birth' ..............................................
Nationality' ..............................................
Country of Residence' ..............................................
Country Where Parcel/Cargo is Sent From' ..............................................
ID Name/Type' ..............................................
ID No' ..............................................
Physical Address' ..............................................
Postal Address' ..............................................
Telephone Numbers (Landline and Mobile)' ..............................................
Email Address(es)' ..............................................
Occupation' ..............................................
Work/Employment Physical Address' ..............................................
21
Anti- i'.1oi,er /.uzlIuk?ru,g (( 'ro.sS-/iar(/w' Declaralivi, o[( 'urrencv (111(1 Bearer Negoii(ib/e /nstru/,,e;,l.$)
Go. 26X
Work Telephone Numbcr(s) .
Marital Status ..............................................
Name of SpouseS ..............................................
Occupation of SpouseS ..............................................
If the recipient is a legal person:
Company/Organisation Name: ..............................................
Name of Company/Organisation Head/CEO ..............................................
Company/Organisation Head/CEO Telephone Numbers (Landline and
Mobile) . ..............................................
Company/Organisation Head/CEO Email Addrcss(es):
Physical Address ..............................................
Postal Address ..............................................
Country: ..............................................
Name of Officer Responsible for the Parcel/Cargo ...........................................
Telephone Numbers of Officer Responsible for the Parcel/Cargo (Landline
and MobiIe) ...........................................
22
Jji/j - /oiic'i I.iii#icIci•iiij_ (C rs.s-I3oi/'r 1)c'cluraiio,, ?/ ( 111 Lm 1 1' a,icf I3','•
.\'cuIhi// In.viru,ne,,Is)
(i. .\..\ ' ( l. 26S (u/ilJ /
59. Company/Organisation Nami .
60. FuH Address . ..............................................
61. Telephone Numbers (Landline and Mobile) ..............................................
62. Name of Officer Handling the Parcel/Cargo ..............................................
63. Duty Station . ..............................................
64. Flight/Vehicle/Vessel No . ..............................................
65. Parcel/Cargo Identification Details . ..............................................
66. Currencies
No Currency Name j Currency Code Total Amount Amount in USD
1
2
3
4
5
TOTAL
67. Bearer Negotiable Instruments (BNI)
No - Bearer Negotiable - Currency
Instrument Name
1 Cheque
- 2 Travelers Cheque -. - -
3 Money Order
4 Bill of Exchange
5 Promissory Note
6 Prepaid Card
7 Other (please specify):
Currency Issuer Total Amount
Code of BNI Amount in USO
TOTAL
23
AnIi-AJo/lej' Laundering ((Doss-Border Declaration oJ(urrencv c,,icl Bearer Negotiable Inslru,neiils)
(L.\.,\o. 268 (c'oiilcl.)
Intended Use of Currency and/or Bearer Negotiable lnstruments . ................
I declare that all the information given on this form is correct and accurate.
Sender/Recipient's Signature: .............................................
Offence Committed (Currency and/or BNI undeclared or Falsely
Declared?) . ..............................................
Receiving Officer's Name:
Date and Time of Seizure ..............................................
Officer's Signature . ..............................................
Dar es Salaam, Pill LI .11' I. M l'ANO()
26 August, 2016 Minis/er/or Finance and Planning
24