Verification and Release List of Imported Goods Which are to be Transited betwee

Applicant: 

                    

Name of entry transport means:          Conveyance reference No.: 

B/L/Waybill No. (master/house):

Entry date:    Piece No.:   Weight: 

Container specification and quantity:

Destination:       Estimated arrival time:

Carrier:

Name and No. of domestic transport tools

Remark:

I hereby state that the above declaration items are truthful, and I am willing to undertake the legal responsibilities therefor. 　

  Applicant seal

Customs declarer

  Date

Customs at the place of entry:

　

　

　

　

 Customs officer:   

   Date