Delivery Verification Statement (Page 2 of 3) in pdf

Delivery Verification Statement Page 2

FORM 6

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

DELIVERY VERIFICATION STATEMENT

PART II

END USER

ITEM CLASSIFICATION NO.

QUANTITY

We (I) declare that all the information provided above is true and correct to the best of

our (my) knowledge.

Delivery Verification Officer’s name and signature:

Date (dd/mm/yy)

INSTRUCTIONS:

1. At the time of making each shipment under the attached permit, please send to your

foreign importer a written request for proof of delivery. Please include in your

request the international import certificate number (if applicable) shown on the front

of this Form and request the foreign importer to make sure that this international

import certificate number appears on the delivery import verification he receives

from his government. You shall submit the documents upon request by the relevant

Authority.

2. The foreign importer shall be advised of the terms of the items description as shown

on the export/ transit/ transhipment/ special* permit, including the unit of measure

(i.e. pounds, kilogrammes, number, etc.) and/ or value of items (as applicable) and

the foreign importer is requested to make sure that these same terms are used on

the delivery verification with the terms on the export/ transit/ transhipment/ special*

permit.

Delivery Verification Statement Page 2