EXPORT DECLARATION AUSFUHRANMELDUNG

DECLARATION D'EXPORTATION UITVOERAANGIFTE

DICHIAZIONE PER L'ESPORTAZIONE

THIS DOCUMENT IS A SINGLE ADMINISTRATION DOCUMENT (SAD) COPY 3 EQUIVALENT CONTAINING INFORMATION DECLARED TO AND ACCEPTED BY UNITED KINGDOM CUSTOMS PROCESSING SYSTEM KNOWN AS CHIEF ON THE DATE SHOWN IN BOX A. THE REFERENCE NUMBER IN BOX A IS A ALLOCATED UNIQUE NUMBER FOR THE DECLARATION. THE FORMAT OF THIS DOCUMENT HAS BEEN AGREED WITH ALL THE CUSTOMS AUTHORITIES OF THE EUROPEAN COMMUNITY IN ACCORDANCE WITH COMMISSION REGULATION 2454/93 ARTICLE 205.3 AND 288

A. Office of dispatch/export

Declaration number:

1. Declaration:

2. Consignor/Exporter

14. Declarant/Representative

3. Forms

5. Items

7. Reference number

15a. Country of dispatch/export

17a. Country of destination

19. Ctr

21. Identity and nationality of active means

of transport crossing the border

25. Mode of transport at the border

26. Inland mode of transport

27. Place of loading

30. Location of goods

32. Item no

33. Commodity code

37. Procedure

31. Packages description of goods marks and numbers

Container No(s)

35. Gross mass (kg)

34. Country origin code

44. Additional information/documents

38. Net-mass (kg)

41. Supplementary units

46. Statistical value

office of export control

office of export control

UK

DOVER

CHIEF

DD-MM-YYYY

123456789012 - 123 A12345A

stamp/stempel/timbre/timbro

A. Office of dispatch/export

2. Consignor/Exporter

1. Declaration

3. Forms

32. Item no

33. Commodity code

37. Procedure

31. Packages description of goods marks and numbers

Container No(s)

35. Gross mass (kg)

34. Country origin code

44. Additional information/documents

38. Net-mass (kg)

41. Supplementary units

46. Statistical value