Delivery Verification Statement printable pdf download

Delivery Verification Statement

FORM 6

[Paragraphs 10(7)(c), 11(7)(c), 12(7)(c) and 13(4)(c)]

DELIVERY VERIFICATION STATEMENT

PART I

Export/Transit/Transhipment/Special*Permit No. :_______________________________

International Import Certificate No. (if applicable) :________________________________

IMPORTANT NOTICE

The ORIGINAL of this Form must be returned to the relevant Authority:

1. for single use/ special permit, no later than 2 months from the date of

export/bringing in transit/transshipment, unless otherwise authorized by the

relevant Authority; or

2. for multiple/ bulk permit, upon request by the relevant Authority.

We (I) certify that (please tick whichever applicable):

The total quantity authorized for export by this permit has been exported and all

delivery verification documents are available upon request by the relevant Authority.

A part of the quantity authorized for export/ transit/ transhipment* by this permit

has been exported/ brought in transit/ transhipped* as detailed in Part II. Delivery

verification documents covering all items exported/ brought in transit/ transhipped*

are available upon request by the relevant Authority.

No shipment has been made against this permit.

Name of permit holder:

Name and title of authorized representative:

Date (dd/mm/yy):

Signature of authorized representative:

Delivery Verification Statement