To be signed by an importer

* Customs House Agents

 1. I/We declare that the contents of Invoice No.(s) ________________________ dated ____________________of M/s _____________________________________________________ and the other documents relating to the goods covered by the said invoice (s) presented herewith are true and correct in every respect.


* Without Customs House Agents

I/We declare that contents of this Bill of Entry for goods imported against Bill of Lading No _________________ dated _________________are in accordance with the Invoice No____________________ dated ______________ and other documents presented herewith.  I/We also declare that contents of the above mentioned invoice(s) and other documents are true and correct in every respect.

2. I/We declare that I/We have not received and do not know of any other documents or information showing a different price value including local payments whether as commission or, otherwise, quantity or description of the said goods and that if at any time hereafter.  I/We discover any information showing a different state of a fact.  I/We immediately make the same known to the Collector of Customs.

3. I/We 3.  I/We declare that the goods covered by the Bill of Entry have been imported on an outright purchase consignment account.

4. I/We am/are not connected with the supplier’s manufacturers as
(a)   agent/distributor/indentor/branch/subsidiary/concessionaire
(b)   collaborator entitled to the use of trade mark, patent or design and
(c)   otherwise that an ordinary importers or buyers.  

5.  I/We 5.  I/We declare that a method of invoicing has not changed since the date on which my/our books of accounts and or arranged with the supplier were examined previously by Customs House.

  *          Strike out whichever is inapplicable



Signature of importer with rubber stamp