[Annex Form No.

1]
《Front page》
Processing Period
Moving-Goods Declaration Immediately
Korea (Green card holder, Non-green card
Per ①Name BAEK KYUNG JA ②Nationality
holder), Foreigner ( )
son
③ ④Passport ⑤Birth Date
Occupation Number
mov Address overseas (nation and city) : ⑦Tel. No. 010 8928 6996
ing ⑥ 11460-A Edmonston Rd. Beltsville, MD 20705 (Mobile phone) ( )
Address Address in Korea (in detail): ROYAL ECO, NO. 201, 8-GIL,
⑧E-mail @
367, INHA-RO, MICHUHOL-GU, 22228 INCHEON [email protected]
to
⑨ (Expected) Residence period (Korean: Residence period abroad, Foreigner & Green card holder:
Expected residence period in Korea : ～
NATIONALITY
Kor * Please make a check for the box where your (expected) residence period belongs to.
ea
□ An individual over 1 year (who moves to Korea) □ With family over 6 months (who moves to Korea)
□ An individual 3 months ~ under 1 year (who stays for a short term) □ With family 3 months ~ under 6 months (who stays for a short term)
Acc ⑪Relations with ⑫Birth Date
om ⑩Name ⑬Passport No. ⑭Occupation ⑮Residence period
the moving person
pan
yin GONZALO SHIPPING 07/07/1962 588386945 DIPLOMATIC 15 DAYS
g
MARTIN AGENT AGENT
fam
ily
T ran  Port of shipment USA B/L(house) No
sp or (Nation) WFDC
t
 Date requesting transport/ 04/23/22 T ransp or t Overseas BUSAN PORT AUTHORITY
Des Arrival date / 08/21/22
cript company
ion  Freight cost (Forwarder) Domestic WFDC
* Please make a check in the appropriate box(□) next to each following question. Please write
down the descriptions of items subject to declaration on the back page in detail.
 Are you bringing the items described below into Korea? YES NO
1. Weapons such as firearms, knives, and cross bows, and bullets; and chemicals, and poisonous or
□ □
radioactive materials (including fake firearms)
2. Narcotics such as opium, heroin, cocaine, methamphetamine, MDMA and cannabis; and drugs violating
□ □
laws such as diet pills.
3. Animals (including meat, leather and fur), plants, fruits, vegetables, or other agricultural
/forestry /fishery products, and other food □ □
4. Endangered animals, plants, or products manufactured from them (tigers, cobras, turtles,
crocodiles, coral, bear's galls, musk, etc.) □ □
5. IPR-infringing goods such as goods labeled with counterfeit trademark, and fake notes and
□ □
securities
6. Goods carried in for the purpose of sales, or corporate goods; or goods delivering at the
request of other people □ □
7. Goods arriving 6 month after the declarant has entered the country □ □
8. Pornographic materials, illegal monitoring equipment; or other items or facts to require
declaration to Customs. □ □
I hereby certify that all statements and information above are true and correct.
Date ( yy 22 mm 08 dd 09 )
Name BAEK KYUNG JA Signature
Attachments 1. A copy of passport(s) or Green Card of the mover and all family members (If necessary)
2. A copy of documents that verifies the period of residence in Korea such as an employment
contract or a rent contract
3. (If necessary) A copy of the certificate of foreigner registration, a certificate of domestic
residence (in case you are a Green Card holder) or a copy of visa (in case you are a foreigner)
4. A copy of Packing List
5. A copy of B/L or Airway Bill
6. A copy of Passenger Baggage Declaration Form or a List of Main Declared Item(s)
7. A copy of a Certificate of Automobile Registration or a Certificate of Ownership
(in case you have an automobile in your declaration items)

×
210mm 297mm(신문용지 54g/㎡(재활용품))
 《back 》
Descriptions of Declared Items
P'kg Model & Quan Purchase Months ※ Customs
Item No. Brand Standards -tity Price(US$) Used use only
1. Goods newly purchased, or have been used less than 3 months before entry
CONSIGNMENT 1 BOX 1
BOX

2. Jewelry, pearls, tortoiseshell, coral, amber and ivory; and

goods made thereof with having the taxation price of KRW 5 million or more per unit

3. Commercial goods, goods not relating with your job

4. Others you want to declare

Automobile Declaration (including motorcycles)

Brand Vehicle Engine Year
NIL Identificati NIL NIL cc Type
Name on No. Displacement NIL
Manuf Registration Dates
acture Seat
NIL Capacity NIL Under your
Nation Initial NIL name NIL
※ Do not write down in the "Customs use only" space. Fill out the box of "Months
Used." If you have items, which have been used for less than the past 3 months,
please list them on the blank spaces.
※ If you find any abnormalities with your goods at the time of inspection, you must
declare them to the inspection officer.
※ If you fail to voluntarily declare goods, including the case where goods that have been
used for no more than three months are declared as having been used for more than
three months, you will be liable for an additional 20% tax in accordance with the Article 241-5
of the Customs Act. Willful failure to declare or untruthful declaration is subject to punishment
under the Customs Act.