Name of the exporter     :

 

Name of the consignee  :

Customs office of departure in the exporter country:

 

Customs office of exit in the exporter country:

 

Customs office of entry in the importer country:

 

Customs office of destination in the importer country:

 

Plate /Flight/Voyage No. :

 

Vehicle Name :

 

Container No.      :

 

Waybill no.      :

 

Holder of the Waybill :

 

A

B*

C*

D*

E

F

G

H

No.

Trademark and No.

of containers

Number (Qty)

and type of containers

 

Description

of goods

 

Gross

Weight

 

Invoice

Date & No.

Invoice Value

 

HS  Code

 

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

…

 

 

 

 

 

 

 

UNDERTAKING

I declare the truth and accuracy of the information that I have provided, and I understand, agree and accept that the information above may be shared with customs authorities of the Russian Federation/Republic of Turkey

 

CERTIFIED BY**

Date:

Title:

Stamp/Seal:

Signature:

DECLARED BY***

 

Date:

Name & Surname:

Signature: