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Entry Form XVII

FORM 17

(See rule 35)

Return of clearing, forwarding, transporting, shipping, etc.

 

Name and address of the clearing, forwarding, house transporting agent/shipping agent or steamer agent ............................................... etc. ................................. the periods to which return relates.

Sl.

No.

Date of clearing, forwarding, transporting shipping

Name and full address of the consignor

Name and full address of the consignee

Number and date of delivery note/ /Bill of landing/ /R.R.etc. No. date

Description of goods

Quantity No. of packings

Weight

Value of Goods

Remarks

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

 

 

 


 


 


 


 


 


 


 


 


DECLARATION

I/We ............................................. declare that to the best of my/our knowledge that the information furnished in the above return is true and correct and that it relates to the period of ...............................................

 

Place:

Date:

Name and signature:

Status of the person signing.

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