To: HM Revenue & Customs, Banking Operations, Central Deferment Office, 6th Floor North West, Alexander House, 21 Victoria Avenue, Southend-on-Sea, SS99 1AA (or fax 01702 36 6091)

This form is to be completed and submitted by the Deferment Approval Number (DAN) holder in all cases. (Please complete in capital letters)

Name of person applying for/holder of Deferment Approval Number

Address

**UK VAT Registration number

Declare that I/we are the holder(s) of the Deferment Approval Number (DAN)

Telephone number

*I/We have applied for a Deferment Approval Number and hereby authorise the † agents/freight forwarders shown to quote the Approval Number when requesting deferment of the charges on all goods imported or removed from warehouse or free-zone by me/us.

Signature

Date

***Status

Key

* Delete as necessary.

** If there are any changes to your VAT Registration number, please notify the Central Deferment Office at the above
address, immediately. Failure to do so could result in delays in the use of your deferment facility.

*** This form must be signed by the importer/proprietor if an individual, by a partner in case of a partnership, or by a
director or the secretary in the case of a limited or other incorporated company.
† Insert here the total number of agents/freight forwarders listed.

For office use

Date

Agent/Freight Forwarder(s) name, address and VAT Registration number

Please ensure the agent/freight forwarder’s VAT numbers are correct. Incorrect numbers will lead to delays in processing this information.

Please indicate below if each agent is to access your deferment balance

Key: Y – Yes N – No