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| Sent by: | Airfreight | Seafreight |
| Port/Airport of loading: | |
| Port/Airport of discharge: | |
| Final Destination: |
| The goods | are subject | are not subject |
| to the Dangerous Goods Regulations (IMDG). |
| Marks | No. and
kind of packages. |
Description | Gross kg | Measurements (cm) |
| Special Regulations: |
| Terms of Delivery: |
| Ex Works | FOB | C&R | CIF | other |
| Transport insurance | to be covered. | NOT to be covered. |
| SLVS is | to be covered. | NOT to be covered. |
| Value of goods for Transport Insurance and SLVS: |
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