anx_II__table__2

Serial No (optional): 1. ELIGIBLE BODY/INDIVIDUAL Designation/name Street and number Postcode, place (Host) Member State 2. COMPETENT AUTHORITY RESPONSIBLE FOR STAMPING (name, address and telephone number) 3. DECLARATION BY THE ELIGIBLE BODY OR INDIVIDUAL The eligible body or individual (1) hereby declares (a) that the goods and/or services set out in box 5 are intended (2) □ for the official use of | □ for the personal use of | □ foreign diplomatic mission | | □ a member of a foreign diplomatic mission | □ foreign consular representation | | □ a member of a foreign consular representation | □ a European body to which the Protocol on the privileges and immunities of the European Union applies | | | □ an international organisation | | □ a staff member of an international organisation | □ the armed forces of a State being a party to the North Atlantic Treaty (NATO force) | | □ the armed forces of a Member State taking part in a Union activity under the common security and defence policy (CSDP) | | □ the armed forces of the United Kingdom stationed in the island of Cyprus | □ for the use of the European Commission or any agency or body established under Union law, where the Commission or that agency or body executes its tasks in response to the COVID-19 pandemic | | (designation of the institution) (see box 4) (b) that the goods and/or services described at box 5 comply with the conditions and limitations applicable to the exemption in the host Member State mentioned in box 1, and (c) that the information above is furnished in good faith. The eligible body or individual hereby undertakes to pay to the Member State from which the goods were dispatched, or from which the goods and/or services were supplied, the VAT and/or excise duty which would be due if the goods and/or services did not comply with the conditions of exemption or if the goods and/or services were not used in the manner intended. Place, date | Name and status of signatory Signature 4. STAMP OF THE BODY (in case of exemption for personal use) Place, date | Stamp | Name and status of signatory Signature 5. DESCRIPTION OF THE GOODS AND/OR SERVICES FOR WHICH THE EXEMPTION FROM VAT AND/OR EXCISE DUTY IS REQUESTED A. Information concerning the supplier/authorised warehousekeeper: (1) name and address (2) Member State (3) VAT/excise number or tax reference number B. Information concerning the goods and/or services: No | Detailed description of the goods and/or services (3) (or reference to the attached order form) | Quantity or number | Value excluding VAT and excise duty | Currency | | | Value per unit | Total value | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total amount | 6. CERTIFICATION BY THE COMPETENT AUTHORITIES OF THE HOST MEMBER STATE The consignment/supply of goods and/or services described in box 5 meets: □ totally | □ up to a quantity of | (number) (4) the conditions for exemption from VAT and/or excise duty Place, date | Stamp | Name and status of signatory Signature 7. PERMISSION TO DISPENSE WITH THE STAMP UNDER BOX 6 (only in case of exemption for official use) By letter No: | Dated: | Designation of eligible institution: Is by | Competent authority in host Member State: Dispensed from the obligation under box 6 to obtain the stamp | Place, date | Stamp | Name and status of signatory Signature (1) Delete as appropriate. (2) Place a cross in the appropriate box. (3) Delete space not used. This obligation also applies if order forms are attached. (4) Goods and/or services not eligible should be deleted in box 5 or on the attached order form. (*) Delete as appropriate.

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Source: EUR-Lex CELLAR · retrieved 2026-07-31 · Text as consolidated on 2025-04-14; changes after this date are not shown.