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Customs Declaration Form of Imported Goods
Pre-input No.: Import Port: Operating Agency: Consignee: License No. Approval No. Contract No. Container No. Marks & Nos. and Remarks
Item No. Commodity Code Name&Specification Quantiy&Unit Place of Origin Unit Price Total Price Currency Exemption
Customs Serial No.: Filing No.: Mode of Transport: Mode of Trade: Date of Importation: Means of Transport: Levy or Exemption: Port of Loading: Premiums Gross Weight (kg) Date of Declaration:
B/L No. Tax Rate Domestic Destination: Sundry Charges Net Weight (kg) Use
Country (Region) of Departure: Mode of Transaction Number of Packages Freight
Kind of Packing
Documents Attached
Levy of Taxes and Fees
This is to hereby declare that the above declaration items are correct. If any item found false, the application entity will bear the legal liability. Keyboarder: Recorde Agency: Declarant: Unit Address: Zip Code: Tel: Application Entity (stamp):
Customs Examination Comment and the Approval Date (stamp should be affixed here) Form Inspector: Tax Collector: Price Inspector: Statistician:
Inspector: Date of Filing:
Approver:

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