UK Direct Representation Form

EUROPEAN UNION DIRECT REPRESENTATION AUTHORISATION
LSA Global Logistics

To: EU Tax Authorities Re: Direct Representative Status for Export Clearances

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Company Name* (“Grantor”), a company doing business in the European Union and having an established business address of Street Address* Address Line 2* City* Zip Code* and customs identification number EORI Number* hereby appoints LSA Global (“Grantee”) with a business address of UNIT 7, Eastgate Office Centre, Eastgate Road, Bristol, BS5 6XX or sub-agent appointed by them, to act as its authorised customs broker.

Grantee shall carry out customs brokerage activities on behalf of the Grantor as set out in the applicable Agreements and SOPs and as a Direct Representative in accordance with Articles 18 and 19 of UCC Regulation (EU) 952/2013 and Section 21 of Taxation (Cross-Border Trade) Act 2018.

In accordance with the Customs Code, a Direct Representative acts in the name of and on behalf of another person. In relation to import/export declarations, the importer/exporter will be liable for any customs debt arising from the declaration.

What are you planning to do ?*

Export from the EU to the UK

Do you have a REX number?*

YesNo

If you have a REX number, confirm it below:

In line with the EU Customs Authorities, we confirm that we have made all necessary checks with the relevant issuing bodies and can confirm the following (Please tick as appropriate):*

Our goods are not subject to further export licensing requirementsOur goods should be considered as not subject to further export license requirements unless we supply specific instructions for an individual shipment at the time of booking.

Declaration

I declare that the information given on this form is true and accurate and I have authority to sign this document on behalf of the company.

Role and Name*

PositionFirst NameLast Name

Phone Number*

Email*

example@example.com

Date*

Date

Signature*