2. Consignor/Exporter [Name and Address]
8. Consignee/Importer [Name and Address]
14. Declaration/Agent [Name and Address]
18. Name of Carrier
Nationality
19. C.F.
21. N/A
25. MOT
26. N/A
27. Place of Loading/Unloading
29. Office of Entry/Departure
30. Loaction of Goods
1. DECLARATION
a
| b
| c. N/A
3. Page
1
4. N/A
5. Items
6. Total Pack
d. Office Code
e. Office Name
f. Manifest No.
g. Registration No.
h. Date.
7. Agent Reference Number:
9. N/A
10. N/A
11. N/A
12. Total Assessable Value
13. N/A
15. Country of Export
15. Country Exp. Code
c N/A
17. Country Des. Code
b N/A
16. Country of Origin
15c. Country of Destination
22. Currency Total Invoice Value
23. Exch. Rate
24. Nat. of Trans.
28. Financial and Banking Data
Sector and Fund Source:
32. Item No: 01
Container Number (s)
Tariff Description of Goods:
Commercial Description and Specification of the Goods:
34. C.O. Code
| b N/A
35. Gross Weight [kg]
36. Agr. Code
37. CPC
38. Net Weight [kg]
39. Visa Ref.
40. Line Number/Sl. Number - Cargo Lading No.
41. Quantity/Unit
42. Item Invoice Value
43. VM Code
45. Adjustment:
46. Item Assessable Value:
Type
Tax Base
Rate
Tax Amount
MP
CD
SD
VAT
AIT
LF
IDSC
AVAT
PSISC
TOTAL:
48. Account Current No.
49. Warehouse Number
Period (Days)
50. ACCOUNTING DETAILS
Mode of Payment:
Assessment No.
Receipt Number:
Guarantee:
DF/VAT:
Total Duty & Taxes:
N/A
Total Gr. & Nt. Wt. (KG)
Description
Invoice Value (FOB/C&F/CIF)
External Freight
Insurance
Landing Charge
Other Dutiable Costs
Allowable Deduetions
G
Amount
N
Curr. Code
Name of Importer/Exporter
Designation
Signature
Date
(FOR OFFICIAL USE ONLY)
Name of Examination/Assessment Officer
Name of Authorized Person
Card No.
