REPUBLIC OF CYPRUS
MINISTRY OF FINANCE
DEPARTMENT OF CUSTOMS AND EXCISE
NICOSIA
Form C. 34
APPOINTMENT BY MASTER OF AN AGENT
Port of: ………………………………….…….
Ship’s name: ………………………………… Ship’s nationality: ………………..…………………
I, …………………………………………………………. being the Master of the above ship
(a) which arrived here from ………………………..…… on …… / …… / 20....... (date)
(i)
do hereby appoint for this voyage (specific appointment)
(agent’s name) ………………………………………….…………………………….… of
(agent’s address) ……………………………………………………………………………
(ii) do hereby appoint (general appointment)
(agent’s name) …………………………………..…………………………………….… of
(agent’s address) ……………………………………………………………………………
to be and act as my agent, to make report as required by section 15 of the Customs Code Law of
2004 and in all matters relating to clearance inwards of the said ship as required of me by
customs legislation.
(b) departing for …………………………………………. on …… / …… / 20....... (date)
(i)
do hereby appoint for this voyage (specific appointment)
(agent’s name) ……………..………………………………………………………….… of
(agent’s address) ……………………………………………………………………………
(ii) do hereby appoint (general appointment)
(agent’s name) ……………………………..………………………………………….… of
(agent’s address) ……………………………………………………………………….…..
to be and act as my agent, to make report as required by section 17 of the Customs Code Law of
2004 and in all matters relating to clearance outwards of the said ship as required of me by
customs legislation.
I hold myself responsible for all my agent’s acts in such matters.
Date: …… /…… / 20……
(Revenue Stamp)
………………………
Master’s Signature
& Ship’s Stamp
N.B. Delete either (i) in the case of a general appointment or (ii) in the case of a specific appointment, in
sections (a) and (b) above.