Transcription of SAD 500 - CUSTOMS DECLARATION FORM 1. DECLARATION …
1 O122. EXPORTER/CONSIGNOR 6 REGISTRATION NO. 78. IMPORTER/CONSIGNEE 5. ITEMS6. TOT PACK7. DECLARANT Reference 10. 11. 12. VALUE DETAILS13A. INVOICE NO. AND DATE14. DECLARANT/AGENT COO17. COD17A. OWNER CODE18. IDENTIFICATION, DATE AND NATIONALITY OF 19. CONT23. RATE OF EXCHANGE21. IDENTIFICATION, DATE AND NATIONALITY OF 28. FINANCIAL DATA24. OTHER COSTS DETAILS25. TMF26. TMI27. PLACE OF DISCHARGE29. 30. LOCATION OF COMMODITY CODEPACKAGESANDDESCRIPTIONOF GOODS34. COC35. GROSS MASS36. PREF-(KGS)ERENCE37. CPC38. NET MASS 39. QUOTA(KGS)40. SUMMARY DECLARATION / PREVIOUS DOC41.
2 SUPP. UNITS42. CUSTOMS ( FCY ) NUMBERDEDUCTED VALUEDEDUCTED QUANTITYADDITIONALINFORMATION/PRODUCEDDO CUMENTS REMOVAL IN BOND ( ) NO, DATE & OFFICEREBATE CODE46. STATISTICAL VALUE IDENTIFICATION OF WAREHOUSE/TIME CALCULATIONLIMITOF DUTIES AND TAXESFOR OFFICIAL USES ignature numberDate17B. REBATE USER CodeSUMMARY OF TOTAL DUTIES AND TAXESOTHER COST32. ITEM 9 NUMBER & TYPE OF PACKAGESOOEMARKS AND NUMBERSRECEIPT NO. & DATE3458 DUTY/TAX BASECodeAmountGUARANTEEAMOUNT UNDERPAIDAMOUNT OVERPAIDOTHER true and correct and comply with the provisions of the CUSTOMS and Excise Act.
3 Being the_____(agent) hereby declare that the particulars herein arethe undersigned of DECLARATIONI, _____TOTAL TOTAL PAYABLEAMOUNT45. OTHER QUANTITIESASSESSMENT NO AND DATEOFF. CODE3. FORMSA. OFFICE OF DESTINATION OR DEPARTURE1. DECLARATIONMANIFEST NUMBERBSIC48. ACCOUNT CODEEX WAREHOUSE CODEDESCRIPTION TYPECONTAINER NUMBERSRATEBSIC-AINERTINTRANSPORT AT FRONTIERA mountCOE20. DELIVERY TERMSFREIGHTINSURANCE22. CURRENCY AND TOTAL VALUEC urrency4. AT ARRIVALSAD 500 - CUSTOMS DECLARATION form TINTINTOTAL DUTIES & TAXES
