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(1) Exporter Consignor (Name and address) (3) Declaration No.
(2) Forwarding agent (4) Customs office
(5) Consignee (6) Buyer if other than consignee
(7) Address for notification or delivery (8) Export licence No. (10) Country of final

destination of


(9) Country of origin
(11) Means of transport (12) Place of shipment (14) Terms of sale and payment

conditions of delivery

(13) Destination of means of transport
(15) Marks and numbers; number and kind of

packages; description of goods

(16) Stat. No. (17) Quantity (18) Value


(20) Declaration for export
(21) Place and date of issue, signature


1. The size of paper (210 x 297 mm), margins, column widths and line spacing of national forms should correspond as closely as possible to the lay-out key in Appendix I.

2. The standardization comprises only questions of size and lay-out, guiding words included in the lay-out key are intended only to indicate the nature of the information which should appear in a given place. Accordingly each country remains free to replace these words in its national form by such wording as it considers more appropriate provided that this wording does not affect the nature of the information as indicated in the lay-out key.

3. In addition it is open to Administrations to omit from their forms items in the lay-out key which they do not require. The spaces which thus become vacant may be used for official purposes.

4. Additional items required by Administrations which are not provided for by the lay-out key in Appendix I could be allocated to the "free disposal area". Similarly the "goods description area" may be extended into the "free disposal area" or vice versa by moving the dotted line.