DECLARATION FORM

(See Rule 10 of Customs Valuation Rules 1988)

NOTE : This Declaration shall not be required for goods imported as passenger's Baggage, goods, imported for personal
use upto Value Rs. 10001- samples of no commercial value or where the goods are subject to specific rate of duty.
Importer's Name and address:
2

Supplier's Name and address:

Name and address of the agent, if any:

Description of goods:

Country of origion :

6
7

Port of shipment:
AWBI BL Number and date

IGM Number and date:

Contract number and date:

10
11

Nature of transaction (sale, consignment, hire, gift, etc.)

Invoice number and date:

12

Invoice value:

13

Terms of payment:

14

Currency of payment:

15

Exchange rate:

16

Terms of delivery

17
18

Relationship between buyer and seller [Rule 2(2)]

If related, what is the basis of deClarevalue:

19

Conditions or restriction attached with the sale [RULE 4(2)]

20

Valuation method application (See Rule 4 to 8)

21

Cost and services not included in the invoice value (Rule9)

(a)

Brokerage and Commissions:

(b)

Cost of containers:

(c)

Packing cost:

(d)

Cost of goods and services supplied by the buyer:

(e)

Royalties and licencefees:

(f)

Value of proceeds which accure to seller:

(g)

Freight:

(h)

Insurance:

(i)

Loading, Unloading, handling charges:

U)

Landing charges:

(k)

Other payments, if any:

22.

Assessable value Rs. :

23.

Previous imports of identical 1similar goods, if any:

24.

(a)

Bill of Entry Number and date:

(b)

IGM Number and date:

Any other relevant information (attach separate sheet, if necessary) :

DECLARATION
I/We hereby declare that the information furnished above is true, completed & correct in every respect.
I/We also undertake to bring to the notice of proper officer any particulars which subsequently come to my1
our knowledge which will have a bearing on valuation.

Place:
Date:

Signature of Importer

FOR CUSTOMS HOUSE USE:

1.
2.
3.
4.
5.
Note: 1.
2.

Bill of Entry Number and Date:

Valuation Methods applied (See Rules 4 to 8) :
If declared value not accepted, brief reasons:
Reference number and date of any previous decision / ruling:
Value assessed:

A.a. Assistant Collector. .

Declaration form in duplicate duly signed by the importer should be attached with original Bill of Entry.
In case Order-in-Original (Speaking Order) is required, Importer / CHA are requested to apply within 30
days. No request on this account will be considered after 30 days.