CASH DECLARATION

Article 3 of Regulation (EU) 2018/1672 – IT D.Lgs. 19/11/2008 n. 195

For official use

Reference number

1. I am

☐ entering the European Union (EU) ☐ leaving the EU ☐ entering the Italy ☐ leaving the Italy

2. Details of the carrier of the cash

First name(s)

Nationality

Last name(s)

Personal identification number*

Gender

☐ male ☐ female ☐ other

Address

Street* and number *

street

number

Date of birth

DD MM YYYY

Town

Place of birth

town

country

Postal / ZIP code*

ID document

☐passport

☐ID card

☐other(specify)_____________

Country

ID document number

Telephone number*

Country of issue

Email address*

Date of issue

DD MM YYYY

3. Transport details

Country of first departure

Departure date

DD MM YYYY

Country of final destination

Arrival date

DD MM YYYY

Via (transit country/-ies)*

Transit date*

DD MM YYYY

Means of transport

☐ AIR (specify)

☐ commercial flight

☐ private jet

☐ other

☐ SEA / FLUVIAL (specify)

☐ commercial vessel ☐ yacht

☐ cruise ☐ other

☐ RAIL

☐ ROAD (specify)

☐ truck ☐ bus

☐ car ☐ other

☐ OTHER (specify)

________________

Itinerary of transport

Name/place of the first airport/port/train station of departure

Name/place of the final airport/port/train station of arrival

Name/place of the airport/port/train station of transit

Land border crossing point (only by road)

Reference number ( e.g. flight number, ship identification, train number, country code and license plate)

Transport company*

4. Details of cash

Currency

(banknotes and coins)

Value

Currency

Value

Currency

Bearer negotiable

instruments

Type of bearer negotiable instrument

Value

Currency

Commodities used as highly-

liquid stores of value

(i.e. gold)

Type

Quantity

Total weight (in grams)

Value

Currency

5. Economic provenance and intended use of the cash (more than one option is possible in each Subsection 5.A and 5.B)

5.A. Economic provenance (This Subsection is filled in when there is only one

owner. If there is more than one owner, the information must be filled in using

additional sheets. In this case, tick ‘other’ and specify ‘additional sheets’)

5.B. Intended use (This Subsection is filled in when there is only one intended

recipient. If there is more than one intended recipient, the information must be

filled in using additional sheets. In this case, tick ‘other’ and specify ‘additional

sheets’)

☐ Labour profits (income, retirement, income from entrepreneurship etc.)

☐ Capital profits (dividends, investment profits, interest, insurance etc.)

☐ Sale of real estate property

☐ Sale of moveable property

☐ Loan granted by a natural person

☐ Loan granted by a legal entity (credit institution, bank or company)

☐ Lottery / gambling

☐ Gift / donation

☐ Inheritance

☐ Other (specify)__________________________________

☐ Labour expenses (salary payments, investment business etc.)

☐ Capital investment (deposits to bank account, insurance payments etc.)

☐ Funds for purchasing real estate

☐ Funds for purchasing moveable property

☐ Repayment of loan granted by a natural person

☐ Repayment of loan granted by a legal entity (credit institution, bank or company)

☐ Lottery / gambling

☐ Charity

☐ Cash to shipmaster/ board cash

☐ Vacation / recreation

☐ Transfer of cash by professional cash couriers (currency exchange companies)

☐ Transfer of cash by professional cash couriers (other)

☐ Other (specify)_________________________________

*If applicable or available. If not applicable or available, indicate ‘N/A’

6. Owner of the cash: Are you the sole owner of the cash?

7. Intended recipient of the cash: Are you the sole intended recipient of the cash?

☐ Yes, I am the sole owner

 Go to Section 7

☐ Yes, I am the sole intended recipient for all cash

 Go to Section 8

☐ No, the sole owner is another natural person

 Fill in Subsection 6.A

☐ No, the sole intended recipient is the sole owner

 Go to Section 8

☐ No, the sole owner is a legal person

 Fill in Subsection 6.B

☐ No, the sole intended recipient is another natural

person

 Fill in Subsection 7.A

☐ No, there is more than one owner

 Fill in the total number of

owners below and use

additional sheets to fill in

their details. Go to Section

☐ No, the sole intended recipient is a legal person

 Fill in Subsection 7.B

☐ No, there is more than one intended recipient

 Fill in the total number

of intendent recipients

below and use additional

sheets to fill in their

details. Go to Section 8.

Total number of owners:

Total number of intended recipients:

6.A. Sole owner is a natural person

7.A. Sole intended recipient is a natural person

First name(s)

Last name(s)

Gender

☐ male ☐ female ☐ other

Gender

☐ male ☐ female ☐ other

Date of birth

DD MM YYYY

Date of birth

DD MM YYYY

Place of birth

town

country

Place of birth

town

country

ID document

☐passport

☐ID card

☐other(specify)

____________

ID document

☐passport

☐ID card

☐other(specify)

_____________

ID document number

Country of issue

Date of issue

DD MM YYYY

Date of issue

DD MM YYYY

Nationality

Personal identification number*

Address

Street* and number*

street

number

Address

Street* and number*

street

number

Town

Postal / ZIP code*

Country

Telephone number*

Email address*

6.B. Sole owner is a legal person

7.B. Sole intended recipient is a legal person

Name

Registration number

Name of register

Registration country

VAT identification number*

Economic Operators Registration

and Identification (EORI) number *

Economic Operators Registration

and Identification (EORI) number *

Address

Street* and number*

street

number

Address

Street* and number *

street

number

Town

Postal / ZIP code*

Country

Telephone number *

Email address*

8. Signature

For official use

I declare that all the details provided are correct. I understand

that if the information provided is incorrect or incomplete, the

obligation to declare shall not be deemed fulfilled and I am liable

to penalties according to the applicable national legislation.

Signature and stamp of the competent authority

Signature

Name of the signee:

Date

DD MM YYYY

Customs declaration: ☐ Yes ☐ No

Place

Town

Country

Customs declaration number:

Total number of additional

sheets used

Endorsed copy requested

☐ Yes

Customs office that performed the control:

*If applicable or available. If not applicable or available, indicate ‘N/A’.

NOTES ON COMPLETION

GENERAL INFORMATION

The obligation to declare cash on entering or leaving the EU is part of the EU’s strategy to prevent money laundering and to fight

terrorism financing. This declaration form must be completed when entering or leaving the EU and carrying EUR 10 000 or more (or

the equivalent in other currencies) in cash (Article 3 of Regulation (EU) 2018/1672 of the European Parliament and of the Council).

If incorrect or incomplete information is provided, or if the cash is not made available for control, the carrier is not considered to

have met their obligation and is liable to penalties under the applicable national legislation.

Information and personal data shall be recorded and processed by the competent authorities and shall be made available to the

Financial Intelligence Unit (FIU) in accordance with Article 9 of Regulation (EU) 2018/1672. In the cases referred to in Articles 10 and

11 of that Regulation, the data will also be made available to the authorities mentioned there. The competent authorities of the

Member State where the declaration is submitted act as controllers of the personal data obtained and will keep personal data

collected in line with Article 13 of Regulation (EU) 2018/1672, by default for 5 years. The processing of personal data takes place only

for the purposes of the prevention and fight against criminal activities. For complete information, including on your rights, see

attached privacy statement/ link to Member State data protection online information.

EXPLANATION OF USED TERMS IN ACCORDANCE WITH REGULATION (EU) 2018/1672

Carrier means any natural person entering or leaving the EU carrying cash on their person, in their luggage or in their means of

transport.

Currency means banknotes and coins that are in circulation as a medium of exchange or that have been in circulation as a medium

of exchange and can still be exchanged through financial institutions or central banks for banknotes and coins that are in circulation

as a medium of exchange.

Bearer-negotiable instruments means instruments other than currency, which entitle their holders to claim a financial amount upon

presentation of the instruments without having to prove their identity or entitlement to that amount. Those instruments are:

(a) traveller’s cheques; [and]

(b) cheques, promissory notes or money orders that are either in bearer form, signed but with the payee’s name omitted, endorsed

without restriction, made out to a fictitious payee, or otherwise in such form that title thereto passes upon delivery.

Commodities used as highly-liquid stores of value

(a) coins with a gold content of at least 90 %; [and]

(b) bullion such as bars, nuggets or clumps with a gold content of at least 99,5 %.

 All fields in the form are mandatory fields and must be completed. Fields in the form marked with an asterisk (*) must be

completed, where applicable or available.

 All parts in white must be completed in block capital letters and dark ink. Forms must not contain crossing out, overwritten

words or other alterations.

 The parts marked ‘for official use’ must remain blank.

 Personal identification number (i.e. personal tax, social security or similar unique personal identification number), address,

postal code / ZIP code, telephone number and email address must be filled in, if applicable. If not applicable, indicate ‘N/A’

instead.

 Value Added Tax (VAT) number and Economic operator registration and identification Number (EORI Number -which is a

unique number, across the EU, assigned by a customs authority in a Member State to economic operators involved in customs

activities) must be filled in where available. If not available indicate ‘N/A’.

 Where information is not known to the carrier, indicate ‘unknown’.

 The form must be completed in one of the official languages of the EU accepted by the competent authorities of the Member

State where the declaration is made.

Section 1: Entering or leaving the EU

Tick the appropriate box to indicate if the carrier is entering or leaving the EU. A declaration on entering and on leaving, is required

also if transiting through the EU.

Section 2: Details of the carrier of the cash

The carrier’s personal data must be filled in this section as they appear on their ID document.

Where the carrier of the cash is not legally capable of signing the declaration, the declaration is submitted by the carrier’s

legal representative.

Section 3: Transport details

Information on the country of first departure, the country of final destination and the means of transport must be provided.

Information on the transit country or countries through which the carrier transfers cash and the transport company must be

specified, if applicable.

- Tick box ‘Air’ if entering or leaving the EU by aircraft. The type of aircraft (commercial flight, private jet, other) must be

provided. The flight number or aircraft registration number (in case of a private jet) must be provided in field ‘Reference

number’.

- Tick box ‘Sea / Fluvial’ if entering or leaving the EU by sea or river. The type of vessel (commercial vessel, yacht or other)

must be provided. The vessel’s name must be provided in field “Reference number” and shipping line details must be

provided under “Transport company”.

- Tick box ‘Road’ if entering or leaving the EU by any kind of motorised road vehicle. The type of road transport (truck, car,

bus, other) must be provided. The country code and licence plate of the vehicle must be provided in the field ‘Reference

number’.

- Tick box ‘Rail’ if entering or leaving the EU by train. The train number must be provided in the field ‘Reference number’

and the train company must be provided under ’Transport company’.

- Tick box ‘Other’ if none of the other transport modes is used and specify the type of transport (e.g. pedestrian traffic,

bicycle).

Section 4: Details of the cash

The total amount of cash carried by the carrier must be filled in this section. ‘Cash’ is defined under ‘General Information’. At least

one of the options [(i) currency; (ii) bearer-negotiable instruments or (iii) commodities used as highly-liquid stores of value] must be

filled in.

If there is insufficient space on the declaration form, the additional sheets must be used to provide the details of the cash. All

information provided constitutes a single declaration and all additional sheets must be numbered and signed.

Section 5: Economic provenance and intended use of the cash

Subsection 5.A must always be filled in if the carrier is a sole owner or if there is only one owner to indicate the relevant economic

provenance.

Subsection 5.B must always be filled in if the carrier is also the sole owner and the sole intended recipient or where there is only

one recipient to indicate the intended use of the cash.

It is possible to select more than one option in each Subsection. If no option is applicable, tick box ‘other’ and specify the details.

If there is more than one owner or more than one intended recipient, the relevant information about the economic provenance and

intended use of the cash for the owners and/or intended recipients must be filled in on additional sheets as mentioned below. In

this case, tick box ‘other’ and specify ‘additional sheets’.

Section 6: Owner of the cash

One owner only

If the carrier is the sole owner of the cash, tick the appropriate box and continue to Section 7.

If the carrier is not the sole owner, specify whether the sole owner is another natural person or a legal person and tick the

appropriate box. The details must be filled in Subsection 6.A (for a natural person) or Subsection 6.B (for a legal person) and

continue to Section 7. If the carrier is a natural person, the personal details must be filled in as they appear on their ID document.

More than one owner

If there is more than one owner, the total number of owners must be filled in the appropriate box. For each additional owner

separate additional sheets must be filled in giving their details, the amount of cash owned and its economic provenance and its

intended use. If the carrier is one of the owners, an additional sheet must be filled in for them as well, with the amount of cash

owned by the carrier and its economic provenance and its intended use. All information provided constitutes a single declaration

and all additional sheets must be numbered and signed.

Section 7: Intended recipient of the cash

One intended recipient only

Indicate whether the carrier is the sole intended recipient of the cash. If that is the case, tick the appropriate box and continue to

Section 8.

If the carrier is not the sole intended recipient, tick the appropriate box to specify if the sole intended recipient is another natural

person or a legal person. The information must be filled in Subsection 7.A (for a natural person) or Subsection 7.B (for a legal

person) and continue to Section 8. In case of natural person, the personal data must be filled in as they appear on their ID

document.

More than one intended recipient

If there is more than one intended recipient, the total number of intended recipients must be filled in the appropriate box. For each

intended recipient separate additional sheets must be filled in giving the details of each intended recipient, the amount of cash to

be received and its intended use. If the carrier is one of the intended recipient an additional sheet must be filled in for them as well,

including the amount of cash received by the carrier and its intended use. All information provided constitutes a single declaration

and all additional sheets must be numbered and signed.

Section 8: Signature

Enter the date, place and name and sign the declaration form. Indicate the total number of additional sheets used. If none has been

used, indicate zero (0). The carrier can tick the appropriate box to request an endorsed copy of the declaration.

CASH DECLARATION - ADDITIONAL SHEET

Article 3 of Regulation (EU) 2018/1672 – IT D.Lgs. 19/11/2008 n. 195

For official use

A. Additional sheet number

Reference number

B. Additional sheet details (Tick only one option. If more options are applicable, fill in separate additional sheets for each additional option)

B.1

☐ Continuation of ‘Details of the cash’

 Fill Section C for additional information on the cash.

B.2

☐ The carrier is the owner and intended recipient of part of the cash

 Fill Sections C and D only for the amount of cash owned and received by the carrier.

B.3

☐ The carrier is the owner of part of the cash

 Fill Sections C and D only for the amount of cash owned by the carrier.

B.4

☐ The carrier is the intended recipient of part of the cash

 Fill Sections C and D.2 only for the amount of cash the carrier receives as a recipient.

B.5

☐ Owner who is also the intended recipient of part of the cash (other than

the carrier)

 Fill Sections C and D for the amount of cash owned and to be received and section E.

B.6

☐ Owner of part of the cash (other than the carrier)

 Fill Sections C and D for the amount of cash owned and section E.

B.7

☐ Intended recipient of part of the cash( other than the carrier)

 Fill Sections C and D2 for the respective amount of cash to be received and section E.

C. Details of the cash

Currency

(banknotes and coins)

Value

Currency

Value

Currency

Bearer negotiable

instruments

Type of bearer negotiable instrument

Value

Currency

Commodities used as highly-liquid

stores of value (i.e. gold)

Type

Quantity

Total weight (in grams)

Value

Currency

D. Economic provenance and intended use of the cash (more than one option is possible in each Subsection D.1 and D.2)

D.1. Economic provenance

D.2. Intended use

☐ Labour profits (income, retirement, income from entrepreneurship etc.)

☐ Capital profits (dividends, investment profits, interest, insurance etc.)

☐ Sale of real estate property

☐ Sale of moveable property

☐ Loan granted by a natural person

☐ Loan granted by a legal entity (credit institution, bank or company)

☐ Lottery / gambling

☐ Gift / donation

☐ Inheritance

☐ Oher (specify)__________________________________

☐ Labour expenses (salary payments, investment business etc.)

☐ Capital investment (deposits to bank account, insurance payments etc.)

☐ Funds for purchasing real estate

☐ Funds for purchasing moveable property

☐ Repayment of loan granted by a natural person

☐ Repayment of loan granted by a legal entity (credit institution, bank or

company)

☐ Lottery / gambling

☐ Charity

☐ Cash to shipmaster/board cash

☐ Vacation / recreation

☐ Transfer of cash by professional cash couriers(currency exchange companies)

☐ Transfer of cash by professional cash couriers (other)

☐ Other (specify)__________________________________

E. Persons involved

E.1. ☐ Natural person

E.2. ☐ Legal person

First name(s)

Name

Last name(s)

Registration number

Gender

☐ male ☐ female ☐ other

Name of register

Date of birth

DD MM YYYY

Registration country

Place of birth

(country/town)

town

country

VAT identification number*

ID document

☐passport

☐ID card

☐other(specify)

________________

Economic Operators Registration

and Identification (EORI) number*

ID document number

Address

Street* and number*

street

number

Country of issue

Town

Date of issue

DD MM YYYY

Postal / ZIP code*

Nationality

Country

Personal identification number*

Telephone number*

Address

Street* and number*

street

number

Email address*

Town

F. Signature

Postal / ZIP code*

I certify that this additional sheet is an integral part of the cash

declaration whereto it is attached.

Country

Signature

Name of the signee:

Telephone number*

Email address*

* If applicable or available. If not applicable or available, indicate ‘N/A’

Date

DD MM YYYY

Place

town

country

Part 3

NOTES ON COMPLETION

General information

The notes on completion of the cash declaration form also apply here.

Section A: Additional sheet number

Additional sheets must be numbered with consecutive numbers (i.e. 1 on the first additional sheet used, 2 on the second etc.).

Indicate the total number of additional sheets used on the second page of the cash declaration form.

Section B: Additional sheet details

State the reason for filling in the additional sheet. Only one option must be ticked. If more options are applicable, use a separate

additional sheet for each option.

B.1: Continuation of ‘Details of the cash’: Select this option only when the space available in Section 4 ‘Details of the cash’ on

the declaration form is not sufficient for all the cash. Fill in Section C and skip Sections D and E.

B.2: The carrier is the owner and the intended recipient of a part of the cash: Select when the carrier is also the owner and

intended recipient of part of the cash. For each other owner and intended recipient a separate additional sheet must be filled

in.

Indicate in Section C the amount of cash owned and the amount of cash to be received.

Indicate in Subsections D.1 and D.2 the economic provenance and the intended use of the cash owned by the carrier.

B.3: The carrier is the owner of part of the cash: Select when the carrier is also the owner of part of the cash. For each other

owner a separate additional sheet must be filled in.

Indicate in Section C the amount of cash owned by the carrier.

Indicate in Subsections D.1 and D.2 the economic provenance and the intended use of the cash owned by the carrier.

B.4: The carrier is the intended recipient of part of the cash: Select when the carrier is also the intended recipient of part of

the cash. For each other intended recipient a separate additional sheet must be filled in.

Indicate in Section C the amount of cash to be received by the carrier.

Indicate in Subsection D.2 the intended use of the cash to be received by the carrier.

B.5: Other owner who is also an intended recipient of part of the cash (other than the carrier): Select when there is more

than one owner, and each owner who is also the intended recipient of the cash. For each other owner who is also an intended

recipient of the cash a separate additional sheet must be filled in.

Indicate in Section C the amount of cash owned by the owner and the amount to be received by the owner and intended

recipient.

Indicate in Subsections D.1 and D.2 the economic provenance and the intended use of the cash owned by the owner and the

intended recipient.

The details of the owner and the intended recipient must be filled in Subsection E.1 if they are a natural person and in

Subsection E.2 if they are a legal person.

B.6: Owner of part of the cash (other than the carrier): Select when there is more than one owner. For each other owner a

separate additional sheet must be filled in.

Indicate in Section C the part of the cash owned by the owner.

Indicate in Subsections D.1 and D.2 the economic provenance and the intended use of the cash owned by the owner.

The details of the owner must be filled in Subsection E.1 if they are a natural person and in Subsection E.2 if they are a legal

person.

B.7: Intended recipient of part of the cash (other than the carrier): Select when there is more than one intended recipient.

For each intended recipient, a separate additional sheet must be filled in.

Indicate in Section C the amount of cash to be received by the intended recipient.

Indicate in Subsection D.2 the intended use of the cash to be received by the intended recipient.

The details of the intended recipient must be filled in Subsection E.1 if they are a natural person and in Subsection E.2 if they

are a legal person.

Section C: Details of the cash

‘Cash’ is explained under the ‘General information’ on notes on completion of the cash declaration.

Section D: Economic provenance and intended use of the cash

Tick the boxes to indicate the relevant economic provenance and intended use of the cash as indicated in Section B. You can select

more than one option. If no option is applicable, then tick box ‘other’ and fill in the details.

Section E: Persons involved

Enter the personal details of the persons involved. These persons can be natural persons or legal persons. You must tick the

appropriate box and fill in the details.

Section F: Signature

State the date, place, name, sign and attach the additional sheet to the main cash declaration form. All information provided

constitutes one declaration.