Ieird Form (Front)
Ieird Form (Front)
Ieird Form (Front)
DECLARATION
Office Code:
1 DECLARATION
Manifest Number:
Entry Number:
3 Page
Date:
5
8 Importer / Consignee ;
Address
TIN:
14 Broker / Attorney-In-Fact;
Address
TIN:
Registry
18 Vessel / Aircraft
19 Ct.
9a Freight
9b
Insurance
10
11
26
13 Tentative
1
2
15 Country of
Export
16 Country of
17
17
15 C.E.
b
20 Terms of
Delivery
22 F. Cur.
7 Reference
6 Tot
23 Exch.
Rate
Total Customs
Value
27 Transhipment
Terms of Payment
Bank Name:
31
Packages
and
Descr.
Branch:
32 Item
No.
34 C. O. Code
35 Item Gross
37
PROCEDURE
36 Pref.
KG
Containers No(s):
40a AWB /
BL.
44 Add.
Infos.
Dos. /
Produ.
Certif.
& Aut.
39
KG
41 Suppl.
Units
4
3
45
Adjustment
46 Dutiable Value
(PHP)
47
Calculation of
Taxes
Type
Tax
Base
Amoun
t
Rat
e
MP
49 Identification of
48
47b ACCOUNTING
DETAILS
Methods of Payment:
Total Fees:
Total
Broker
Date
Administering Officer /
Notary Public
51
Date
S
Print Name
Date
Print Name
24