Print Form
H.M.Customs Trade Declaration
_________
_________
_________
[__] IMPORT [__] EXPORT [__] DEPOSIT [__] ADJUSTMENT
1 SUPPLIER DETAILS
ID:
________________
5 SHIPMENT DETAILS
a. NAME:
a. CITY OF DIRECT SHIPMENT:
b. STREET:
b. COUNTRY OF DIRECT SHIPMENT:
c. CITY, STATE/PROV.:
c. COUNTRY OF ORIGINAL SHIPMENT:
d. ZIP / POST CODE:
6 ADDITIONAL INFORMATION
e. COUNTRY:
2 IMPORTER DETAILS
ID:
________________
7 TOTAL NO. OF RECORDS: _______________
a. NAME:
b. PO BOX, STREET:
8 TOTAL FREIGHT: _______________________
c. TOWN, ISLAND:
d. POST CODE:
3 TRANSPORT DETAILS
9 TOTAL INSURANCE:_______________________ _
a. CARRIER ID / NO.:
Total Customs Duty:
Total Wharfage
:
b. PORT OF ARRIVAL:
Total Alcohol
:
c. ARRIVAL DATE:
4 MANIFEST DETAILS
NO.:
________________
Total Form
:
a. NO. OF PACKAGES:
Total Fossil Fuel
:
b. BILL OF LADING / AWB:
10 TOTAL DUTY
:
c. CONTAINER ID & LENGTH:
11 RECORD NO.: 001
12 CPC: _____________________________________
18 F.O.B. VALUE: _________________________
13 TARIFF NO.: _______________________________
19 CHARGES / DEDUCTIONS
AMOUNT
14 COUNTRY OF ORIGIN: ______________________
15 NO. AND TYPE OF PACKAGES: ______________
16 DESCRIPTION
20 C.I.F. VALUE: __________________________
21 TAX
| IND. | VALUE | RATE
AMOUNT
|
|
|
|
|
|
17 a. NET WEIGHT (LB): _______________________
b. QUANTITY/UNITS: _______________________
|
|
|
22 ADDITIONAL INFORMATION
TOTAL:
Customs Use Only
DECLARANT NAME: ______________________________
DECLARANT ID: _________________________________
I/We declare that the above particulars are true and correct.
SIGNATURE:
DATE:
HMC-12 (10/12)