Dear Sir or Madam,

You will find below the authorization form required to authorize our Customs Agency to act on your behalf before the customs and
tax administration authorities. This authorization allows you to use comprehensive customs services in all branches of our company.

We kindly ask you to:

n Correctly fill out all the fields in the document This will allow you to go through customs clearance quickly
and efficiently. It is necessary to indicate the EORI number. You can find more information here:
https://www.podatki.gov.pl/clo/informacje-dla-przedsiebiorcow/eori/ .

n Place a signature in accordance with the company’s representation by a person / persons authorized to do so.
A handwritten signature or a qualified electronic signature is required.

n Send the original authorization to the following address: DHL Express (Poland) Sp. z o.o. ul. Wirażowa 37 02-158 Warsaw
– with the annotation: “Authorization for the Customs Agency”. In Poland, you can use the link below and select from the list:
DHL AC GTW-WAW – https://app.dhlexpress.pl/acdhl. If the documents are sent from a country other than Poland, use other
available options. Documents with a qualified electronic signature should be sent back by e-mail.

In order to verify and speed up the registration process, please send a scan of the authorization to the e-mail address from which you
received the information or to a different address, provided by an employee of the DHL Customs Agency. We kindly ask you to send
the original document without undue delay so that we can complete the customs clearance of the goods as soon as possible.

Submission of the authorization requires the payment of stamp duty in the amount of PLN 17.00. You can pay it yourself or ask us to
do so. Should the payment be made by us, the amount will be re-invoiced.

If you have any questions regarding the completion of the authorization, please contact us.

The administrator of your personal data will be DHL EXPRESS (POLAND) Sp. z o. o., with its seat at: ul. Wirażowa 37, 02-158 Warsaw.
The data will be processed for the purpose of customs services and the implementation of the contract of carriage. Everyone has the right
to access their personal data, rectify them, delete them, limit processing, transfer, object to their processing and submit a complaint to the
President of the Office for Personal Data Protection. We would like to inform you that the Administrator has appointed a Data Protection
Officer who can be contacted in all matters regarding the processing of personal data at the postal address of the Administrator’s seat or
electronically via the e-mail address: pl.dhlexp.iod@dhl.com.

More information on the processing of your personal data is available at: https://www.dhl.com/pl-en/home/footer/privacy-notice.html
in the tab: “Shipper and Shipment Receiver”.

DHL Express – Excellence. Simply delivered.

DHL Express (Poland) Sp. z o.o. Sąd Rejonowy dla m. st. Warszawy
ul. Wirażowa 37 KRS 0000047237
02-158 Warszawa NIP 527 00 22 391
kontakt.int@dhl.com REGON 012005407
dhlexpress.pl Kapitał zakładowy 419 000,00 PLN

FSJ-17.2.1.16 – Authorization to act as a direct representative (for company) Version 4, valid from 1 August 2022
 ............................................. ..............................................................................................................................
Date City

AUTHORIZATION
to act as a direct representative

I authorize DHL Express (Poland) Sp. z o.o. (hereinafter: “DHL”) with its seat in Warsaw at ul. Wirażowa 37, 02-158 Warsaw,
(REGON: 012005407; NIP: 527-00-22-391) to act on behalf of the Authorizing Party, i.e.:

...................................................................................................................................................................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................................................................................................................................................
Name and seat of the Authorizing Party

EORI: ....................................................................................... VAT ID: ....................................................................................... NIP: .......................................................................................

in the following activities related to DHL making customs declarations of outgoing shipments to or by the Authorizing Party:

1. To examine the identity of the goods before submitting a customs declaration,

2. To prepare the necessary documents as part of the customs declaration,
3. To make customs declarations on the basis of the information and documents provided,
4. To secure the customs debt and to pay duties and taxes,
5. To collect the goods after they are released,
6. To submit applications and take actions necessary to handle customs declarations made on the basis of this authorization,
7. To represent the Authorizing Party before other tax administration authorities.

This authorization covers DHL’s right to substitute power of attorney. Any changes to the data of the entity or information about the
withdrawal of this authorization shall be reported immediately in writing.

The Authorizing Party is obliged to:

1. Pay DHL the equivalent of customs and tax duties resulting from customs declarations made by DHL, stamp duty, as well
as fees resulting from the DHL International Services Price List available at: https://dhlexpress.pl (including the outlay
commission for using DHL security) – labeled “Duties and Taxes Importer”).
2. Provide all information and documents necessary for the correct filing of the customs declaration. The Authorizing Party
declares that the information and the documents provided are true, reliable and complete. The Authorizing Party is liable
for damage suffered by DHL due to incorrect, inaccurate or incomplete information and documents provided by or on behalf
of the Authorizing Party, unless the damage is caused by DHL.

FSJ-17.2.1.16 – Authorization to act as a direct representative (for company) Version 4, valid from 1 August 2022
Additional information:

AEO* certificate number: ......................................................................................................

* Not required, provide the number if it has been issued.

List of contact persons in matters related to customs clearance:

Responsible for:
First name Last name Phone number E-mail address Import Export Transit

1 NO NO NO

2 NO NO NO

3 NO NO NO

4 NO NO NO

5 NO NO NO

E-mail address(es) used to send electronic messages confirming the completion of customs clearance:

E-mail address Import Export Transit E-mail address Import Export Transit

1 NO NO NO 6 NO NO NO

2 NO NO NO 7 NO NO NO

3 NO NO NO 8 NO NO NO

4 NO NO NO 9 NO NO NO

5 NO NO NO 10 NO NO NO

The authorization is:

permanent temporary until .............................................

.......................................................................................................................................
Signature of the Authorizing Party acting on behalf of the Company

....................................................................................................................................... .......................................................................................................................................
Date and signature of the person acting on behalf of DHL Full name of the Authorizing Party

FSJ-17.2.1.16 – Authorization to act as a direct representative (for company) Version 4, valid from 1 August 2022