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ANNEXURE - A
DECLARATION FORM FOR IMPORT OF GOODS
A. Bill of Entry Master Details
1. CHA Details -
CHA Licence Number :
Name:
Address of CHA :
2. Importer Particulars -
Importer/Exporter Code:
Branch serial Number:
Importer Name:
Address:
Type of Importer (select one):
G
U
O
P
Government Departments:
Government Undertakings:
Diplomatic / UN and its Organisations:
Others:
Authorised Dealer Code of the Bank
3. Type of Bill of Entry
H
W
XA. Type of Bill of Entry
(a) Home Consumption:
(b) Warehouse:
(c) Ex-bond:
(d) Ex-bond Details:
Into Bond B/E No. Into Bond B/E DateWarehouse Code
No. of package to be released Package Code Gross weight Unit of Measurement Additional charges if any for purchases of high seas (HSS) in (INR) Miscellaneous Load (in INR) Ex-bond Release Details:
B Bill of Entry filing status
NPA
(a) Normal B/E: after filling of IGM and after entry inward.
(b) Prior B/E: after filling of IGM and before entry inward.
(c) Advance B/E: filed before filling of IGM and before entry inward.
4. High Sea Sale Details -
YESNOHigh Sea Sale (HSS)
(ii) If Yes, High Sea Sellers Particulars:
Importer Exporter Code(IEC):
Branch Serial Number:
Name of High Sea Seller:
Address:
YESNO5. Section 46(1) Proviso case:
6. Special Requests, if any -
YESNO (a) First Check requested:
YESNO (b) Urgent clearance against
Temporary documentation
(Kacha BE):
YESNO(c) Extension of time limit
under Section 48:*
*If yes, reason for late filing:
7. Other Details -
(a) Port of shipment:
(b) Country of Origin (if same for all goods of consignment):
(c) Otherwise declare at Item level:
(d) Country of consignment:
B. Import General Manifest Details
8. IGM Details -
IGM No:.
Date of Entry Inward:
9. MAWB/MBL Details -
MAWB/MBL No.:
Date of MAWB/MBL:
10. HAWB/HBL Details -
(a) HAWB/HBL No.:
(b) Date of HAWB/HBL:
11. Commodity Details
A. Package Details -
(a) Number of package:
(b) Type of package:
B. Weight Details -
(a) Gross Weight:
(b) Unit of weight:
C. Marks & Numbers:
12. Additional information for clearance of goods at ICDs -
(a) Name of the Gateway port:
(b) Gateway IGM Number:
(c) Date of Entry Inward at Gateway port:
13. Container details (in case of clearance at ICDs and sea ports), wherever applicable -
Container NumberSeal NumberFCL/LCL(1)(2)(3)
C. Bond & Certificate Details
14. Bond Details
YESNO (a) Whether clearance of imported goods is against any
type of Bond already registered with Customs:
(b) If yes, provided particulars of Bond:
Type of BondBond Regn No.Warehouse (WH)100% EOUs etc. (EO)Provisional Duty (PD)Job-work (JB)End Use Bond (EU)Undertaking (UT)Re-export Bond (RE)EPCG (EC)DEEC (DE)DFRC (DE)REPL (DE)
15. Certificate Details
(a) Procurement Certificate details from Central Excise Commissionerate:
(i) Certificate Number:
(ii) Date of Certificate:
(iii) Commissionerate Code:
(iv) Division Code:
(v) Range Code:
(b) Miscellaneous Certificate Details :
(i) Certificate Number:
(ii) Title & Address of Issuing authority
D. Invoice Details
16. Single /Multiple Invoice
Yes/No (a) For Ex Bond BE Invoice Serial No:
(b) Whether Import under multiple Invoices:
(c) If Yes,
(i) No. of Invoices:
(ii) Total Freight:
(iii) Total Insurance:
17. Details of each Invoice
(a) Invoice No.: Date:
(b) Purchase Order No.: Date:
(c) Contract No.: Date:
(d) Letter of Credit (LC) No. Date:
(e) Supplier Details:
(i) Supplier Name: (ii) Supplier Address:
Supplier Country:
(f) If Supplier And seller are not same:
(i) Seller Name:
(ii) Seller Address:
(iii) Seller Country:
Broker/Agent Details:
(i) Broker/Agent Name: (ii) Broker/Agent Address:
(iii) Broker/Agent Country:
(h) Nature of Transaction (Tick)
(i) Sale: (ii) Sale of Consignment Basis: (iii) Hire: (iv) Rent: (v)Replacement: (vi) Gift: (vii) Sample(viii) Other Free of Cost:
(i) Terms of payment (Tick):
(i) LC: (ii) FOC: (iii) DP: (iv) SD: (v) Others:
(j) Conditions or restriction attached to sale, if any:
(k) Terms of Invoice (Tick):
(i) FOB: (ii) CIF: (iii) CI:(iv) CF:
(l) Invoice Charges:
(i) Invoice Value (ii) Invoice Currency:
(m) Method of valuation applicable:
(n) Freight, insurance and other charges -
Rate(%)AmountCurrency1%
(i) Freight:
(ii) Insurance:
(iii) Loading, unloading and
handling charges -Rule 9(2)(b):
(iv) Other charges related to the
carriage of goods:
(o) Cost and services not included in the Invoice value and other miscellaneous charges:
Charges Rate (%) Amount Currency
(i) Brokerage and commissions:
(ii) Cost of containers: (iii) Cost of packing: (iv) Dismantling, transport and handling
charges at the country of export or
any other country (v) Cost of goods and services supplied
by buyer (vi) Documentation (vii) Country of origin Certificate (viii) Royalties and license fees (ix) Value of proceeds which accrue to
seller (x) Cost of warranty services, if any,
provided by the seller or on behalf of
the seller (xi) Other costs or payments, if any , to
satisfy the obligation of the seller
(xii) Other charges and payment, if any
(p) Discount charges
(i) Whether Discount:
(ii) If Yes,
(A) Nature of Discount (B) Rate (%) or Amt.
(q) Additional Charges for purchase on High Seas, if any
(i) Rate (%) or Amount
(r) Any other relevant information which has a bearing on Value:
(s) Details of SVB Loading wherever applicable (at Invoice level):
(If same for all goods of the consignment, otherwise declare at the Item level at S.No.39)
(i) Whether the buyer and seller are related: Yes/No
(ii) if yes, whether the relationship examined earlier Yes/No
by SVB:
(iii) If Yes,
/ A. Reference No./ Date
B. Customs House:
Assessable Value Duty Both C. Load On:
Assessable Value Duty D. Loading Rate (%):
E. Provisional/Final
Provisional Final
E. Item Details
18. Detailed Description of Item
(a) Invoice Serial No.
(b) Actual Invoice No.
Sr.No.DescriptionItem :1Item :2Item :3Item :41.Item serial No. in Invoice 2.Item Description 3.Generic Description 4.Unit Price 5.Quantity 6.Unit of Quantity 7.Accessories, if any 8.Manufacture's Name 9.Brand 10.Model/Grade/Specification 11.End-use of the Item 12.Country of Origin 13.previous ,imports ifanyB/E No. 14.Date15.Unit Value 16.Currency 17.Custom House
19. Classification Details -
(b) Actual Invoice No. (a) Invoice Serial No.
Sr.No.DescriptionItem: 1Item: 2Item: 3Item: 41.
Item serial No. in Invoice
2. Classification Details RITC Code 3.CTH (Preferential/Standard)P/SP/SP/SP/S4.CTH Notn./ Sr. No. 5.CETH6.CTH Notn. / Sr.No 7.Educational cess Notn. / Sr.No. 8.SIA Notn. / Sr.No. 9.SED Notn. / Sr.No. 10.TTA Notn./ Sr.No. 11.NCD Duty Notn./ Sr.No. 12.Anti Dumping Notifications Notn./ Sr.No. 13.Item Sr.No in Notification 14.Quantity 15.Supplier Sr.No. 16. Classification Details Tariff Value Tariff Value Notification No. 17.Sr.No. of the Item in Notification 18.Quantity 19.SAFTA Notn./Sr.No.20.Health Notn./Sr.No.21.Additional CVD Notn/Sr.No.22.Aggregate Duty Notn/Sr.No. 23.Safeguard Duty Notn/Sr.No. 24.Re-import(Y/N)25.RSP per unit 26.SVB Details SVB Ref. No. 27.SVB Date28.Custom House 29Load Assess Value 30Load on Duty 31.Provisional(P)/Final (F)32.Import Licence DetailsFTP Schemes Code, if any 33Import against Licence (Y/N)34.Para No. /Year of Exim Policy
20. Shipping Bill Details in case of Reimport -
(b) Actual Invoice No.: (a) Invoice serial No.:
Sr.
No.DescriptionItem :1Item :2Item :3Item :4.1.Item serial No. in Invoice
2.Shipping Bill Number
3.Shipping Bill Date
4.Port of Export
5.Invoice number of SB
6.Item Sr.No. in SB
7.Notn.No./Notn Serial No.
8.Payment made for export on Pro-rata basis (in Rs.)Freight
9.Insurance
10.Calculated Customs Duty
11.Calculated Excise Duty
21. Additional Duties under Section 3(3) -
(b) Actual Invoice No.: (a) Invoice serial No.:
Sr. No.DescriptionItem:1Item : 2Item: 3Item: 41.Item Sr.No. in Invoice 2.Notn.No./ Notn Sr/No.
3.Duty Type (E)
4.Additional Duty Flag(x)
22. Details relating to duty Exemption on FTP Schemes and Licence particular -
(b) Actual Invoice No.: (a) Invoice serial No.:
Sr.No.DescriptionItem :1Item :2Item :3Item :41.Item serial No. in Invoice 2.Additional Duty Exemption Requested (Y/ N) 3.Notification Sr.No. 4.Licence Registration No. 5.Licence Registration date 6.Debit Value (Rs.) 7.Debit Quantity8.Unit 9.Item Sr.No. in Licence
23. I hereby enclose the copies of following import documents -
(b) Packing list (a) Invoice
Note : Where the Invoice contains more than one unit of Item and more than one description of Items, UNIT PRICE of each Item shall be mandatory.
DECLARATION
I certify that aforesaid declaration, the documents & the information contained therein are true, correct and complete in all respects.
Dated Signature:Name of the Signatory: Name of the Importer / Authorised Customs House Agent:
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