Freezone Facility Charge (FFC) Declaration Form 2019

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Freezone Facility Charge (FFC) Declaration Form 2019

Freezone Facility Charge (FFC) Declaration Form 2019

The FFC declaration can be submitted online. A copy of the form will be sent to your provided email address.
For questions or further details please contact your account executive at +297 582 0909 or account.executive@fzanv.com.

This contact form is available only for logged in users.

Received Cash Payments Form

Freezone company name:

Part I: Identity of individual from whom the cash was received

1. Last name(s):

2. First name:

3. Address:

4. Place:

5. Country:

6. Date of birth:

6. Place of birth:

7. Occupation, profession or business:

8. Document used to verify identity:

8.1 Document issuing country:

8.2 Number:

8.3 Issuing Date:

8.4 Expiration Date:

8.5 Copy on file: YesNo

If more than one individual is involved, please complete the information on additional forms for the other individuals

Part II: Person/Business on whose behalf this transaction was conducted

9. Individual’s full name or name of business:*

10. Address:*

11. Place:*

12. Country:*

Part III: Description of transaction and method of payment

13. Date cash received:*

14. Multiple payments?* YesNo

15. Total cash received (in U.S. dollar equivalent):* $

16. Select currency:*

By submitting this form I declare to be authorized to provide this specific information and that the information provided is complete and correct. Free Zone Aruba (FZA) NV accepts this electronically submitted form as if it was a signed hard copy, and retains the right to request hard copies of the submitted forms.

Date:*

Name:*

Email: * receive a copy.

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