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SAD 500 - CUSTOMS DECLARATION FORM 1. DECLARATION A. OFFICE OF DESTINATION OR DEPARTURE
2 2. EXPORTER/CONSIGNOR OFF. MANIFEST NUMBER
3 TIN CODE
4
5 BSIC
6 3. FORMS 4. REGISTRATION NO. ASSESSMENT NO AND DATE
7
8
9

8. IMPORTER/CONSIGNEE 5. ITEMS 6. TOT PACK 7. DECLARANT Reference NO. RECEIPT NO. & DATE
TIN

BSIC 9. 10. 11. 12. VALUE DETAILS 13. 13A. INVOICE NO. AND DATE

14. DECLARANT/AGENT 15. 16. COO 17. COD 17A. OWNER CODE Code
TIN COE

20. DELIVERY TERMS

18. IDENTIFICATION, DATE AND NATIONALITY OF 19. CONT22. CURRENCY AND TOTAL VALUE 23. RATE OF EXCHANGE
TRANSPORT AT ARRIVAL -AINER

21. IDENTIFICATION, DATE AND NATIONALITY OF 28. FINANCIAL DATA 24. OTHER COSTS DETAILS
TRANSPORT AT FRONTIER
Currency Amount

FREIGHT

25. TMF 26. TMI 27. PLACE OF DISCHARGE

INSURANCE

29. 30. LOCATION OF GOODS

OOE
OTHER COST

31. 32. ITEM 33. COMMODITY CODE

PACKAGES
MARKS AND
AND
NUMBERS
DESCRIPTION
OF GOODS
34. COC 35. GROSS MASS36. PREF-
NUMBER & (KGS) ERENCE
TYPE OF
PACKAGES

37. CPC 38. NET MASS 39. QUOTA

CONTAINER (KGS)
NUMBERS

DESCRIPTION 40. SUMMARY DECLARATION / PREVIOUS DOC

41. SUPP. UNITS 42. CUSTOMS VALU43.V.M

( FCY )

44. LICENCE NUMBER DEDUCTED VALUE DEDUCTED QUANTITY

ADDITIONAL EX WAREHOUSE CODE 45. OTHER
INFORMATION/ QUANTITIES

PRODUCED
DOCUMENTS REMOVAL IN BOND (R.I.B.) NO, DATE & OFFICE REBATE CODE 46. STATISTICAL VALUE

47. TYPE DUTY/TAX BASE RATE AMOUNT MP 48. ACCOUNT CODE 49. IDENTIFICATION OF WAREHOUSE/TIME
CALCULATION LIMIT
OF DUTIES

AND TAXES

SUMMARY OF TOTAL DUTIES AND TAXES

TOTAL DUTIES & TAXES

AMOUNT OVERPAID

AMOUNT UNDERPAID

OTHER

TOTAL PAYABLE

TOTAL
GUARANTEE Code Amount

DECLARATION FOR OFFICIAL USE

the undersigned of
I, ________________________________ _________________________

being the ____________________ (agent) hereby declare that the particulars herein are

true and correct and comply with the provisions of the Customs and Excise Act.

Signature I.D number Date