| FORM OF REGISTRATION FORM |
| CUSTOMS BROKERS & CUSTOMS CLERKS COMMISSION |
| REGISTRATION FORM |
| File No ........................................ Date ........................................ |
| The Secretary |
| Customs Brokers & Customs Clerks Commission |
| c/o Customs & Excise |
| Castries. |
| Name of firm ................................................................................ |
| Address of firm ................................................................................ |
| The following employee(s) currently possess a customs clerk licence – |
| Name | Date of employment | Customs Clerk grade and licence No. | Specimen Signature |
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| The following employee(s) currently possess an apprentice permit– |
| Name | Date of employment | Apprentice Permit No. | Specimen Signature |
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