Anexo III 

  Date of birth (dd/mm/yyyy) 

Address in Brazil (Hotels/Cities/States) or telephone or e-mail 

  Arrival date (dd/mm/yyyy) 

ACCOMPANIED BAGGAGE DECLARATION

MINISTÉRIO DA FAZENDA
SECRETARIA DA RECEITA FEDERAL DO BRASIL

READ CAREFULLY BEFORE FILLING OUT THE FORM

There is no need to declare the following items:
•	books, leaflets and newspapers;
•	clothing and traveller’s objects for personal or professional use;
•	goods acquired abroad, in total value up to US$500,00 (air or maritime travel) or up to US$300,00 (land, river or lake border crossing)
•	goods purchased in duty free shops upon arrival in the country.

DUTYABLE GOODS
The customs duty is a flat rate of 50% on the value exceeding exemption limits.
The exemption limit is personal and can only be used once in a period of a month. 

QUANTITATIVE LIMITS
The special taxation applies only to the goods that do not exceed the following quantitative limits:
•	alcoholic beverages: 12 liters in total
•	cigarettes: 10 packs in total, containing 20 units each;
•	cigars and cigarillos: 25 units in total;
•	tobacco: 250 grams in total;
•	goods not mentioned in the previous items, valued under US$ 10,00 each (air  or maritime travel), or US$ 5,00 (land, river or lake boarder crossing): 20 units in total, since there are up to 10 identical goods; and
•	goods not mentioned in the previous items: 20 units (air or maritime travel), or 10 units (land, river or lake boarder crossing) in total, since there are up to 3 identical goods.

RESTRICTIONS AND PROHIBITIONS
 Narcotic drugs, psychotropic substances or similar drugs, and counterfeit and pirated goods are prohibited from entering the country.  Travellers under 18 years of age are not allowed to carry alcoholic beverages and tobacco products.
Products subject to sanitary inspection or of animal / vegetable origin will only be released after authorization by the National Health Surveillance Agency or the Ministry of Agriculture.
Motor vehicles and their parts; goods in an amount or quality that reveals commercial / industrial destination; goods over the quantitative limits are subjected to taxation under the COMMON IMPORT PROCEDURE.

CURRENCY CARRY-ON ELETRONIC DECLARATION (e-DPV)
Travellers carrying over R $10.000,00 cash or its equivalent in other currencies must fill out the e-DPV (currency carry-on electronic declaration). It must be filled out before departure, through the Internet (www.receita.fazenda.gov.br/dpv) or at RFB’s terminals available at ports, airports and border points facilities. The form must be presented to a customs officer for validation.

*More information can be obtained at: www. www.receita.fazenda.gov.br/bens de viajante 

www.receita.fazenda.gov.br

Passport or identity card number

Country of residence    	          Country of origin 

___/___/______

Flight no or vehicle identification

 Seat/Cabin

Full name

___/___/________

City and country of departure

Place of stop/connection

PERSONAL DATA

CPF (if resident in Brazil)

Espaço Reservado à Propaganda  ou Promoção Comercial

For official use only

Date (dd/mm/yyyy) 

    I declare the information is true.

Traveller´s Signature

Have you been to agricultural or cattle-raising areas on the last 15 days?

BAGGAGE INFORMATION

Are you bringing in your baggage:
1. animals, vegetables or their parts, seeds, animal or vegetal-products, veterinary or toxic products?
2. medical products, in vitro diagnosis products, cleaning products, biological material?
3. medicaments, except those for personal use, or food of any kind?
4. firearms or ammunition?
5. goods subjected to restrictions or prohibitions or to the common import regime (see instructions on the obverse)?
6. goods worth over US$ 3,000.00 (air or maritime travel) or any value (land, river or lake border crossing), for temporary admission? (Non-residents only)
7. goods subject to special taxation (see instructions on the obverse)?
8. currency (cash) in an amount over R$ 10,000.00 or its equivalent in a foreign currency?

NO

YES

•	If you have answered YES to questions 6 or 7, list the effects in the table below.
•	If you have answered YES to question 8, you must also present the Currency  Carry-on Electronic Declaration (e-DPV), for validation. 
•	If you have answered YES to any of the above questions, choose the GOODS TO DECLARE channel.
•	If you have answered NO to all questions, choose the NOTHING TO DECLARE channel.

LIST OF GOODS
(Fill out the blanks only if you have answered YES to questions 6 or 7 in the table Baggage Information)

Quantity	Description of goods	Value
(US$)	

			

	                                                        Total Value (US$)		

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

YES

___/___/______

Full name

Passport or identity card number                                     CPF (if resident in Brazil)