Of… No…
The following particulars must be given in the order shown:
ATA carnet No:
…
Date of endorsement of voucher:
…
Holder and address:
…
Chamber of commerce:
…
Country of origin:
…
Date of expiry of carnet:
…
Date set for the re-exportation of the goods:
…
Customs office of entry:
…
Customs office of temporary admission:
…
Trade description of goods:
…
…
…
CN code:
…
Number of pieces:
…
Weight or volume:
…
Value:
…
Breakdown of duties and taxes:
…
Type Taxable amount Rate Amount Exchange rate
Total:
(Total in words:…)
Customs office:
…
Place and date:
…
SignatureStamp
Delete whichever is inapplicable.