ANNEXURE ORIGINAL DUPLICATE

DECLARATION FORM

( See Rule 10 of Customs Valuation Rules, 1988)

Note: This declaration shall not be required for goods imported as passengers baggage, goods imported for personal use upto value of Rs.1000/-. Samples of no commercial value, or Where the goods are subject to specific rate of duty.

1.	Importer Name & Address:
2.	Suppliers Name & Address:
3.	Name & Address of agents, if any :
4.	Description of goods:
5.	Country of origin:
6.	Port of Shipment:
7.	AWB/BL Number & Date:
8.	IGM Number & Date :
9.	Contract Number & Date :
10.	Nature of Transaction (Sale Consignment, Hire, Gift etc.)
11.	Invoice Number & Date :
12.	Invoice Value :
13.	Terms of Payment :
14.	Currency of Payment:
15.	Exchange Rate :
16.	Terms of Payment :
17.	Relationship between buyer and sellter [Rule 2 (2)]
18.	If related, what is the basis of declared value:
19.	Conditions of Restrictions attached with the sale [Rule 492)]
20.	Valuation Method applicable, (See Rule 4 to 8)
21.	Cost and service not included in the invoice Value (Rule 9)
	[a]	Brokerage and Commissions.
	[b]	Cost of containers.
	[c]	Packaging cost:
	[d]	Cost of goods and services supplied by the buyer:
	[e]	Royalties and licence fees:
	[f]	Value of proceeds which accrue to seller:
	[g]	Freight:
	[h]	Insurance:
	[i]	Loading, unloading and handling charges:
	[j]	Loading charges :
	[k]	Others payment, if any:


22.	Assessable value in Rs.
23.	Previous imports of identical/similar goods, if any:
	[a]	Bill of Entry Number and Date:
	[b]	IGM Number and Date:
24.	Any other relevant information (Attach separate sheet, if necessary)

DECLARATION

1. I/We hereby declare that the information furnished above is true, complete and correct in every respect. I/We also undertake to bring to the notice of proper office any particulars which subsequently came to my/our knowledge which will have a bearing on valuation.

Place:

Date: Signature of Importer

FOR CUSTOMS HOUSE USE

1. Bill of Entry Number and Date

2. Valuation Method Applied (See rule 4 to 8)

3. If declared value not accepted, brief reasons

4. Reference Number and date of any previous decisions/ruling

5. Value Assessed

A.O Assistant Collector

Note

1. Declaration form in Duplicate duly signed by the importer should be attached with Bill of Entry.

2. In case Order-in-Original (Speaking Order) is required, Importer/CHA are

3. Requested to apply within 30 days. No request on this account will be considered after 30 days.