Memorandum of Cash Deposited Under
Section 42 of the Customs Act 1901
NOTICE: The following information is required under the Customs Act 1901 and Customs Regulation 2015, to ensure that a valid security or
undertaking is in place for your goods so that they can be properly cleared for import. The information you provide will be given to the
Australian Bureau of Statistics and the Australian Taxation Office. If you are required to hold a permit to import these goods, the permit details
will also be given to the relevant permit issuing agency.
Import Declaration ID:
OWNER DETAILS
Security ID:
BROKER DETAILS (if applicable)
Owner ID: (ABN/CAC or CCID)
Branch Name:
Owner Name:
Broker Reference:
Owner’s Reference:
Department House Box No.:
* The owner will be recorded as the depositor unless other arrangements are nominated. See the reverse of form for details of nomination process.
THE GOODS:
Goods Description: Air or Sea Bill Number:
Number of Packages:
Mode of Transport:
First Arrival Port Code:
Arrival Date:
SECURITY TO BE LODGED:
Pursuant to the requirement of the Collector for the State of …………………………………………………………………………........................... the sum
of……………………………………………..……..dollars……………………..…..cents, is hereby deposited with the Collector as security in respect of the
above mentioned goods, and the condition of the security is that if:
(Place X in appropriate box)
Within six months from the date of this memorandum or such further time as the Collector may in writing allow, produce evidence to allow the
Collector to determine that the above mentioned goods have been properly described, valued, or rated for duty.
Every obligation, provision and condition contained in or imposed by the Customs Act 1901 and the Customs Regulation 2015 made there
under, or any departmental by-law or determination or the relevant entry and applicable to the goods specified above is at all times duly
observed performed and complied with to the satisfaction of the Collector for the State of
………………...………………………….……...………………………….……...………………………….……...………………………….………….…
Other (where applicable, please specify by-law number or the ministerial determination number DVwell as the item number
………………...………………………….……...………………………….……...………………………….……...………………………….………….…
Then the deposit will be returned to the depositor
Name and Signature of Owner/Broker:
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Date:
(B739 )HE 201)
TO BE COMPLETED BY APPLICANT
Return of Security deposit
Address to which advice of payment or cheque for refund of security amount is to be sent:
Address ...............................................................................................…………………………….....…………………………….....…………………………….
……………………………………………………………………………………………………………......…………………………….....…………………………….
NOTE: a completed Order To Pay Agent (OTPA) form must be presented to the Department of Immigration and Border Protection if the security
deposit is to be refunded to someone other than the owner as nominated on this form.
Preferred method of payment:
EFT payment to a bank account registered in ICS for this owner.
EFT payment to another account (OTPA required)
BSB Number:…………………………………………………………………….
Account Number:………………………………………………………………..
Account Name:…………………………………………………………………..
Cheque (OTPA required if other than nominated owner.)
OFFICIAL USE ONLY:
Security Lodgement
Security Return
Security Details
Deposit:
$ .......................……..... c .......…………..............................
*may be returned to depositor
*Security amount of:
$ .......................................... c ........................................
may be retained on deposit.
*Undertaking for payment of duty may be accepted.
Deposit:
$……............................. c .................................…………....
*may be transferred to revenue
Date
Date
Signature ...………….....………………………………..……………………...
Signature ...………….....………………………………..……………………...
Name of Officer .................................…………………………………….......
Name of Officer .................................…………………………………….......
.................................…………………………………….......………………….
.................................…………………………………….......………………….
Examination on Importation (if applicable)
Examination on Exportation (if applicable)
Examining
Officer
Examining Officer
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Date
Date
(B739 )HE 201)