Port of Loading:РDomestic Destination:РApproval No.РMode of TransactionРFreight РPremiums РSundry ChargesРContract No.РNumber of PackagesРKind of PackingРGross Weight (kg)РNet Weight (kg)РContainer No.РDocuments AttachedРUse РMarks & Nos. and Remarks?РItem No. Commodity Code Name&Specification Quantiy&Unit Place of Origin Unit Price Total Price Currency ExemptionРLevy of Taxes and FeesРThis is to hereby declare that the above declaration items are correct. If any item found false, the application entity will bear the legal liability.РKeyboarder: Recorde Agency:РDeclarant:РUnit Address: Application Entity (stamp):РZip Code: Tel: Date of Filing:РCustoms ment and the Approval Date (stamp should be affixed here)РForm Inspector: Price Inspector:РTax Collector: Statistician:РInspector: Approver:
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