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