combination: invoice - declaration by foreign shipper … · combination: invoice - declaration by...
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COMBINATION: INVOICE - DECLARATION BY FOREIGN SHIPPER
FOR CUSTOMS CLEARANCE BY
EXPORTER, SELLEREXPORTATEUR, VENDEUR
PRODUCER OF GOODS (IF DIFFERENT THAN EXPORTER)FABRICANT DES MARCHANDISES (SI AUTRE QUE L’EXPORTATEUR)
BUYER (IF DIFFERENT THAN CONSIGNEE)ACHETEUR (SI AUTRE QUE LE DESTINATAIRE)
SHIPPED TOEXPÉDIÉ À
IRS NUMBERIRS NUMBER
INVOICE UNIT QTY.QTÉ UNITAIRE
INVOICE UNIT PRICEPRIX UNITAIRE
INVOICE TOTALTOTAL DE LA FACTURE
L 10 EX 1/00
INVOICE / FACTURE
PREPARER (IF OTHER THAN EXPORTER)PRÉPARATEUR (SI AUTRE QUE L’EXPORTATEUR)
NAME OF RESPONSIBLE EMPLOYEE OF EXPORTERNOM DE L’EMPLOYÉ RESPONSABLE CHEZ L’EXPORTATEUR
To the best of the knowledge and belief of the preparer this invoice is true andcomplete and discloses the true prices, values, quantities, rebates, drawbacks, fees,commissions, royalties and any goods or services provided to the seller either free orat a reduced cost.
MARKS AND NUMBERSMARQUES ET NUMEROS
NUMBER AND KIND OF PACKAGESNOMBRE ET CATÉGORIE DE COLIS
SHIPPING WEIGHTPOIDS À L’EXPÉDITION
PARTIES TO THIS TRANSACTION ARELES TRANSACTIONNAIRES SONT
U.S. DUTY / BROKERAGE FOR ACCOUNT OFDROITS DE DOUANE/COURTAGE É.-U. POUR LE COMPTE DE:
COUNTRY OF FINAL DEST. (IF OTHER THAN U.S.A.)PAYS DE DESTINATION FINALE (SI AUTRE QUE LES É.-U.)
RELATEDASSOCIÉS
NOT RELATEDNON ASSOCIÉS
FREIGHT AMOUNT INCLUDEDMONTANT DU FRET COMPRIS
FREIGHT AMOUNT TO BORDERMONTANT DU FRET À LA FRONTIÈRE
COUNTRY ORIGIN OF GOODS
:
PAYS D’ORIGINEDES MARCHANDISES
EXPORTER / EXPORTATEUR
SHIP TO CONSIGNEE / EXPÉDIER AU DESTINATAIRE
OTHER (SPECIFY) / AUTRE
BROKERAGECOURTAGE
FREIGHTTRANSPORT
DUTYDROITS
ABOVE PRICES INCLUDELES PRIX CI-DESSUS COMPRENNENT:
DECLARATION BY FOREIGN SHIPPER (To be completed only when the goods described above are of U.S. origin and their value exceeds $2000.00)
I
or manufacture of the United States: That they were exported from the United States from the port of
that they are returned without having been advanced in value or improved in condition by any process of manufacture or other means.
declare that the articles herein specified are to the best of my knowledge and belief, the growth, produce
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on or about
SHIPPER SIGNATUREDATESIGNED
DESCRIPTION OF GOODSDESCRIPTION DES MARCHANDISES
SIX DIGIT H.S. NUMBERNUMÉRO DE SIX CHIFFRES DU S.H.
SHIPMENT REFERENCE: