	Kingdom of Saudi Arabia Ministry of Finance Saudi Customs		Declaration Form
		Date: Time:

According to Article 14 of Anti-Money Laundering Law

This Form must be filled out by whoever carries SR60,000 or more, or the equivalent of other currencies, bearer negotiable instruments or precious metals.

Full Name:

Nationality: Date of Birth:

Passport or ID #:

Place of Issue: Date of Issue:

KSA Address & Tel. No.:

Address in Destination Country:

Purpose of Travel:

Arriving from: Departing to:

Name of the Airport/ Seaport/ Crossing Border: Flight No.:

Cash Amounts, Negotiable Instruments or Precious Metals

Currency Type: Amount:

Negotiable Instruments:

Amount in Riyals:

Metals: Gold Diamond Other Jewelries

Value in Riyals:

Source / Purpose of cash amounts / negotiable instruments /precious metals:

I hereby acknowledge that the information declared above is correct and I shall be criminally responsible for any mis-declaration.

Traveler Signature: Date:

Official Use

Employee Name: No:

Signature: Date:

Not declaring will expose you to legal questioning .