(TO BE PLACED ON YOUR COMPANY’S
LETTERHEAD)

TO WHOM IT MAY CONCERN

In accordance with Section 181 of the Customs Act (1901), we hereby authorise Specific
Freight Pty. Ltd. to act as our agent, and further authorise them to make customs, GST and/or
AQIS declarations on our behalf.

In consideration of them acting as our Customs Agent, we hereby indemnify and agree to
indemnify them against any claims and demands made against them arising from any
customs, GST and/or AQIS declarations that they make on our behalf.

We hereby agree to pay all charges in connection with the undertaking of this service(s)
including all or any of the following: freight, duty/GST, clearance, transport and other
disbursement costs and, in accordance with Specific Freight Pty. Ltd’s Standard Trading
Terms and Conditions.

Name……………………………………………………………………………………………
Position…………………………………………………………………………………………
Company Name……………………………………………………………………………….
ABN no…………………………………………………………………………………………..

Signature……………………………………………………………………………………….
Date……………………………………………………………………………………………..
Company Stamp