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Physical
Currency 2 Business/residential address in home country (not a P.O. Box)
$10,000 or more
CARRYING CURRENCY INTO
OR OUT OF AUSTRALIA
State
Complete this form if you are moving AUD10,000 or more of physical Postcode
currency (or the equivalent in foreign physical currency). Physical Country
(if not Australia)
currency is defined in the AML/CTF Act as the coin and printed
money of a country but does not include traveller's cheques and/or Phone No
other monetary instruments.
3 Are you an Australian resident?
Please complete this form in black ink and print in CAPITAL
LETTERS. Mark appropriate answer boxes with a cross (X). Yes No Please specify your address while in Australia
Give the completed form to a customs or police officer at any
Australian air or sea port at the time of your arrival or departure.
For further information visit www.austrac.gov.au or telephone the
AUSTRAC Contact Centre on 1300 021 037. State Postcode
Phone No
Passport no.
2.
Country of issue
OFFICE USE ONLY 8 Give details of all countries of which you are a citizen
Country 1
I Voluntary declaration Yes No
Country 2
II Name, date of birth and passport verified Yes No
III Currency verified PART B - DETAILS OF TRAVEL
Yes No
IV Officers name 9 Direction of travel OUT OF Australia INTO Australia
10 What is the name of the Australian city/town where you are clearing
Customs?
V Name of port
14 Give details of the currency being carried to the nearest whole number
Currency Currency
Code Amount of Currency Code Amount of Currency
A U D
State Postcode
Country Phone No
(if not Australia)
18 Occupation, business or principal activity of this person, business or organisation ACN, ABN or ARBN
PART E IF NOT FOR YOURSELF, TO WHOM ARE YOU DELIVERING THE CURRENCY?
19 What is the full name of the person, business or organisation to whom the currency is being delivered?
State Postcode
Country Phone No
(if not Australia)
21 Occupation, business or principal activity of this person, business or organisation ACN, ABN or ARBN
Signature
SIGN
HERE
Date D D MM 2 0 Y Y