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