CIRCULAR

STIPULATING FORM DECLARATION, ANNEX DECLARATION FOR TRANSIT GOODS  AND REGIME OF PRINTING, ISSUANCE, MANAGEMENT, USE OF DECLARATION, ANNEX DECLARATION FOR GOODS IN TRANSIT 

Pursuant to the Law on Customs No.29/2001/QH10, of June 29, 2001 and the Law on Customs No.42/2005/QH11, of June 14, 2005 amending and supplementing a number of articles of the Law on Customs; 

Pursuant to the Commercial Law No.36/2005/QH11, of June 14, 2005;

Pursuant to the Government’s Decree No.154/2005/ND-CP, of December 15, 2005 detailing a number of articles of Law on Customs on customs procedures, customs inspection and supervion;

Pursuant to the Government’s Decree No.12/2006/ND-CP, of January 23, 2006 detailing the implementation of the Commercial Law on international purchases and sales of goods; and agency for sale and purchase, processing and transit of goods involving foreign parties; 

Pursuant to the Government’s Decree No.118/2008/ND-CP, of November 27, 2008 defining the functions, tasks, powers and organizational structure of the Ministry of Finance; 

For implementation of the Government’s Resolution No.68/NQ-CP, of December 27, 2010 on simplifying administrative procedures within management function of the Ministry of Finance and implementation of official dispatch No.854/TTg-KSTT, of May 31, 2011 of the Prime Minister on solving difficulties, problems of Ministries, branches in the course of executing plan on simplifying administrative procedures;  

...

...

...

The Minister of Finance promulgates Circular stipulating declaration form, annex declaration for goods in transit and regime of printing, issuance, management, use of declaration, annex declaration for goods in transit,

Article 1. To promulgate together with this Circular

1.  Form of Declaration for goods in transit (symbolized as HQ/2012-QC);

2. Form of Annex Declaration for goods in transit (symbolized as PLHQ/2012-QC);

3. Annex guides method to record criterion on declaration, Annex declaration for goods in transit.  

Article 2. Provisions on Forms of Declaration and Annex Declaration for goods in transit

1. Declaration for goods in transit (symbolized as HQ/2012 – QC) and Annex declaration for goods in transit (symbolized as HQ/2012 – PLQC) are printed bilingually in Vietnamese and English (herein after referred to as declaration and Annex declaration); each type of declaration and Annex declaration includes 02 copies (01 copy kept by Customs and 01 copy kept by the declarant).

2. Declaration and Annex declaration have pink background and phrase “QC” on their background; sizes of Declaration and Annex declaration are A4 (21cm x 29.7cm).

3. The customs declarants use Declaration and Annex declaration in order to do customs procedures for goods in transit.

...

...

...

1. The duties of the General Department of Customs:

a) The General Department of Customs organize printing and management of Declaration and Annex Declaration for goods in transit.

b) Allocating declarations and Annex-declarations for Customs Departments of provinces, cities periodically.

c) Implementing inspection of allocation, management of declarations and Annex-declarations intra vires.

2. The duties of the Customs Departments of provinces, cities:

a) Allocating declarations and Annex-declarations for each affiliated Customs sub-department (there is logbook of specific quantity for each Customs sub-department) and guiding specifically on management, preservation, use of declarations and Annex-declarations.   

b) Implementing inspection of allocation, management of declarations and Annex-declarations intra vires.

c) Periodically reporting to the General Department of Customs about the use demand of declarations and Annex-declarations

3. The duties of the Sub-Department of Customs:

...

...

...

b) Guiding the customs declarants in use of declarations and Annex-declarations as prescribed in Article 4 of this Circular.

c) Allocating declarations and Annex-declarations for customs declarants.

d) Collecting customs fee for goods in transit as prescribed.

e) Implementing inspection of allocation, management of declarations and Annex-declarations intra vires.

Article 4. Provisions on use of Declaration and Annex Declaration for goods in transit

1. The customs declarants may declare directly on declarations and Annex-declarations or declare under standard form of declarations and/or Annex-declarations on computer and content of declaration printed out on declarations (HQ/2012-QC), and/or Annex-declarations (HQ/2012-PLQC). 

2. The customs declarants upon declaring directly on declarations and/or Annex-declarations and customs officers upon registering book of declaration, confirming result of actual inspection for goods, signing on declarations and/or Annex-declarations may use only type of ink, not use red ink, pencil or kinds of easy-fading ink, not clearly presenting content declared, registered, confirmed, not erase, repair content declared, registered, confirmed on declarations and/or Annex-declarations.

Article 5. Implementation provisions

1. This Circular takes effect on December 01, 2012.

...

...

...

3. The director general of the General Department of Customs and relevant agencies, organizations, individuals shall implement content specified in this Circular.

FOR THE MINISTER OF FINANCE
DEPUTY MINISTER



Do Hoang Anh Tuan

ANNEX

GUIDING METHOD TO RECORD ON DECLARATIONS AND/OR ANNEX-DECLARATIONS FOR GOODS IN TRANSIT (promulgated together with the Circular No.186/2012/TT-BTC, of November 02, 2012 of the Ministry of Finance) 

Criterion /Boxs on declarations and/or Annex-declarations  

...

...

...

The Upper left corner of declaration

The customs declarants declare name of Customs Departments, Customs Sub-Departments where registering declaration and doing custom procedures for goods in transit.

The central part of declarations, Annex-declarations

Declaration number, registration day is ordinal number of daily declarations at each Customs Sub-Departments; Annex number: Being ordinal number of each Annex attached with each declaration; the customs officers record the declaration number, notation of Customs Sub-Department's name (where registers declaration) under an order: Declaration number and Annex declaration number / name of Sub-Department registering declaration / QC and PLQC Particularly, name of Sub-Department registering declaration may record code of team in according to specific regulation of each Sub-department.

The upper right corner of declaration

The customs officers registering customs declaration clearly write full name, seal their stamp.

Box 1 of declaration

The customs declarants declare clearly, fully full name (organization, agency, trader, individual being owner of goods), address, number of identification card/ passport (if being individual), tax code (if being trader)

Box 2 of declaration

...

...

...

Box 3 of declaration

The customs declarant clearly declare: Contract number, day of signing contract and expiry day of contract.

Box 4 of declaration

The customs declarants clearly declare: Permit number, day of issuing permit and effective day of permit for goods in transit.

Box 5 of declaration

The customs declarants clearly declare: Number, notation of container containing goods in transit and quantity of containers If cargo in transit is transported by many containers which cannot declare all in declaration, the declarant may make a detail of list enclosed with declaration in transit.

Box 6 of declaration

The customs declarants clearly declare (just applying for goods in transit performing storage in Vietnam):  Place and period of storage

Box 7 of declaration

...

...

...

Box 8 of declaration

The customs declarants clearly declare: Name, number sign of means of transportation of entry and day of arrival If cargo in transit is transported by many containers which cannot declare all in declaration, the declarant may make a detail of list enclosed with declaration in transit.

Box 9 of declaration

The customs declarants clearly declare: Number and date of bill of lading or equivalent voucher.

Box 10 of declaration

The customs declarants clearly declare: Name of Entry checkpoint

Box 11 of declaration

The customs declarants clearly declare: Name of Exit checkpoint

Box 12 of declaration

...

...

...

Box 13 of declaration, section I of Annex-declaration

Name and description of goods:

- The customs declarants declare, describe specifically goods (name and description of goods) under documents relating to cargo. 

a) If the cargo has over 05 (five) items, the customs declarants  declare in box 13 as follows:

- On customs declaration: declaring total of items declared in Annex declaration.

- On Annex declaration: Declaring, describing specifically each item.

b) If the cargo is set a HS code but it has many details, items, the customs declarants  declare in box 13 as follows:

- On customs declaration: Declaring common name of cargo.

- Allowing to make detail of list; not required to declare on Annex declaration

...

...

...

HS code:

- The customs declarants declare HS code under the corresponding HS code in preferential import and export tariff list promulgated by the Ministry of Finance. 

- If the cargo has over 05 (five) items, the declarant fills in box 14 as follows:

+ On customs declaration: not required to declare on declaration.

+ On Annex declaration: Declaring clearly, specifically code of each item.

Box 15 of declaration, section I of Annex-declaration

Country of Origin:

- The customs declarants base on name of country (where manufactures, products goods) presented on goods or base on certificate of origin as prescribed and documents relating to cargo (if any) in order to declare in box 15.

- If the cargo has over 05 (five) items, the customs declarants declare in box 15 as follows:

...

...

...

+ On Annex declaration: Declaring clearly, specifically origin of each item.

Box 16 of declaration, section I of Annex-declaration

Measurement Unit:

- The customs declarants declare name of Measurement Unit of each item (such as: Piece, set, kg, m, etc) Being exact with Measurement Unit as prescribed in the list of Vietnam’ s export, import goods promulgated by the Ministry of Finance.

- If the cargo has over 05 (five) items, the customs declarants declare in box 16 as follows:

+ On customs declaration: not required to declare on declaration.

+ On Annex declaration: Declaring clearly, specifically Measurement Unit of each item.

Box 17 of declaration, section I of Annex-declaration

Quantity:

...

...

...

- If the cargo has over 05 (five) items, the customs declarants declare in box 17 as follows:

+ On customs declaration: not required to declare on declaration.

+ On Annex declaration: Declaring clearly, specifically goods quantity of each item.

Box 18 of declaration, section I of Annex-declaration

Original currency unit price:

- The customs declarants declare foreign currency price of a goods unit according to Measurement Unit of declaration in box 16.

- If the cargo has over 05 (five) items, the customs declarants declare in box 18 as follows:

+ On customs declaration: not required to declare on declaration.

+ On Annex declaration: Declaring clearly, specifically original currency unit price of each item.

...

...

...

Original currency value:

- The customs declarants declare original currency value of each item (specified as follows: (Quantity of goods in box 17) x (original currency unit price in box 18).

- If the cargo has over 05 (five) items, the method of declaration in box 19 as follows:

+ On customs declaration: declaring total original currency value of items declared in Annex declaration.

+ On Annex declaration: Declaring clearly, specifically original currency value of each item.

Box 20 of declaration, section I of Annex-declaration

Documents enclosed:

The customs declarants declare documents (original/copy) relating to cargo in transit (if any) such as:  Contract for goods in transit, bill of lading; Permit for goods in transit, storage permit, etc  

Box 21 of declaration, section I of Annex-declaration

...

...

...

- If goods are ownership of individuals, customs declarants sign, clearly write full name, not required for seal in box 21 of declaration, section I of Annex declaration; 

- If goods are ownership of agencies, organizations, traders, the customs declarants sign, clearly write full name, and seal their stamp in box 21 of declaration, section I of Annex declaration;

Box 22 of declaration

The customs officers examining goods at the exit checkpoint writes day of re-export of cargo.

Box 23 of declaration

Writing norms as guided in box 13 of declaration.

Box 24 of declaration

The customs officers examining goods at the exit checkpoint writes actual quantity of re-export goods.

Box 25 of declaration

...

...

...

Box 26 of declaration

The customs officers examining goods at the exit checkpoint writes name of exit checkpoint.

Box 27 of declaration

Confirmation of head of Customs Sub-Department of entry checkpoint.

Box 28 of declaration

Confirmation of head of Customs Sub-Department of exit checkpoint.

Box 29 of declaration, section II of Annex-declaration

The customs officers examining goods at the entry checkpoint:  Examining status of packing, customs sealing, recording result of examining, having a signature and seal of officer in this box.

Box 30 of declaration, section II of Annex-declaration

...

...

...

Box 31 of declaration

- The customs officers receive dossier of liquidity submitted by the customs declarants and implement liquidity for declaration of goods in transit under current provisions

Box 32 of declaration

The customs officers stick customs fee stamp.

HẢI QUAN VIỆT NAM / VIETNAM CUSTOMS

HQ/2012-QC

TỜ KHAI HÀNG HÓA QUÁ CẢNH / DECLARATION FOR GOODS IN TRANSIT

(Bản Hải quan lưu / for Customs)

TỔNG CỤC HẢI QUAN / GENERAL
DEPARTMENT OF VIETNAM CUSTOMS

...

...

...

Chi cục Hải quan/Sub-Customs Department …….

…………………………………………………………..

Tờ khai / Declaration No:.........../QC

Ngày đăng ký / Date of registration:

Số lượng phụ lục tờ khai / Number of Appendix:

…………………………………………………….

…………………………………………………….

Công chức đăng ký / Customs officer responsible for registration: ……………..

(ký, ghi rõ họ tên, đóng dấu công chức / Signature, seal)

...

...

...

1. Người khai hải quan / Declarant:

Tên/Name ………...........................

.......................................................

Địa chỉ / Address: …………............

…………………………………........

Mã số thuế (nếu có)/ Tax code (if any):…………………………..........

2. Người vận chuyển /Transporter(ghi rõ tên / name) …………………………

...........................................................

Địa chỉ/Address: ………………………

...

...

...

3. Hợp đồng quá cảnh / Conttact for goods in transit:

Số/ No:    …………………………………

Ngày/Date:. ……………………………...

Ngày hết hạn/ Expiry date-

d/m/y:…./……/20 ……………………..

…………………………………....………

4. Giấy phép quá cảnh / Permit for goods in transit:

Số/No: …………………………….

Ngày/Date:. …………………......

...

...

...

……………………………………..

5. Số lượng container / Quantity of container …………………………............

Số, ký hiệu container / Number, notation of

container …………………………………………

………………………………………………………………………………..

……………………………………………………………………………….

6. Địa điểm, thời gian lưu kho / Place, period of storage:..............................

…………………………………....………

…………………………………....………

...

...

...

……………………………………..

……………………………………..

…………………………………….

8. Phương tiện vận tải nhập / Means of transportation of entry: ………………………………

Tên số hiệu/Name of Number sign: ………………..

Ngày đến / date of arrival: ………………………….

………………………………………………………….

9. Vận tải đơn / Bill of Iading / Air way bill ….

……………….............

...

...

...

Ngày phát hành/ Date of issue: ….........……

10. Cửa khẩu nhập / Entry checkpoint:

……………………

……………………

……………………

11. Cửa khẩu xuất/ Exit checkpoint: …….

…………………..

…………………..

…………………..

...

...

...

Ngày đi /date of departure: ……

Tên số hiệu/Name of Number sign:

..........……………………………..

Tuyến đường/line: …………….

……………………………………

Số TT/No

13. Tên hàng, quy cách phẩm chất / Name and description of goods

14. Mã hàng hóa
HS code

15. Xuất xứ
Country of Origin

...

...

...

17. Lượng hàng Quantity

18. Đơn giá nguyên tệ
Unit Price

19. Trị giá nguyên tệ
Value

1

...

...

...

2

...

...

...

4

...

...

...

5

...

...

...

Tổng cộng/Total:

20. Chứng từ kèm / attached documents:

- Hợp đồng quá cảnh / Contract for goods in transit: ……………………..

- Bản kê chi tiết / The detail of List ………………………………………….

...

...

...

- Giấy phép quá cảnh /Permit for goods in transit  ……………………….

- Khác/other: ………………………………………………………………….

21. Tôi xin cam đoan chịu trách nhiệm trước pháp luật về nội dung khai trên / I hereby declare and shall be responsible for the above submited information

Ngày / tháng / năm / (dd/mm/yyyy): ……./ …../……..
(Ký, ghi rõ họ tên và đóng dấu / Signature, full name and seal of declarant)

B. PHẦN DÀNH CHO HẢI QUAN / FOR CUSTOMS

Ngày xuất / Date of Exit

Tên hàng, quy cách phẩm chất / Name and description of goods

Lượng hàng thực tái xuất/ Exactly quantity to re-export

Lượng hàng còn lại chưa tái xuất/ Quantity of remaining not to re-export

...

...

...

Xác nhận của Chi cục Hải quan Cửa khẩu nhập / Authentication by Sub- Customs Department of Entry checkpoint

Xác nhận của Chi cục Hải quan Cửa khẩu xuất / Authentication by Sub-Customs Department of Exit checkpoint

22

23

24

25

26

27

28

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

29. Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu nhập / Authentication by Customs officer responsible for examining on of Entry checkpoint:

(Ký, đóng dấu công chức / Signature, seal)

...

...

...

30. Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu xuất/ Authentication by Customs officer responsible for examining on of Exit checkpoint

(Ký, đóng dấu công chức / Signature, seal)

31. Xác nhận thanh khoản của công chức Hải quan/ Liquidity of Customs officer:

Ngày / tháng / năm/ (dd/mm/yyyy): ……../…./………………………………

(Ký, đóng dấu công chức / Signature, seal)

...

...

...

32. Ô dán tem lệ phí hải quan / Place to stick Customs fees stamp:

HẢI QUAN VIỆT NAM / VIETNAM CUSTOMS

HQ/2012 - PLQC

PHỤ LỤC TỜ KHAI HÀNG HÓA QUÁ CẢNH
APPENDIX DECLARATION FOR GOODS IN TRANSIT

(Bản Hải quan lưu / for Customs)

Phụ lục số / Appendix No:……………………………….

...

...

...

Ngày đăng ký/ Date of Registraion: ……………………

I. PHẦN DÀNH CHO NGƯỜI KHAI HẢI QUAN / FOR DECLARANT

Số
TT/No

Tên hàng, quy cách phẩm chất / Name and description of goods

Mã số hàng hóa
HS code

Xuất xứ
Country of Origin

Đơn vị tính
Measurement Unit

Lượng hàng
Quantity

Đơn giá nguyên tệ
Unit Price

...

...

...

1

2

...

...

...

3

...

...

...

4

...

...

...

5

...

...

...

6

7

...

...

...

8

...

...

...

9

...

...

...

10

...

...

...

Tổng cộng/Total:

Số lượng Container/ Quantity of container ………………………

Số, ký hiệu Container / No, notation of container   ………………

…………………………………………………………………………

…………………………………………………………………………

………………………………………………………………………..

…………………………………………………………………………

…………………………………………………………………………

...

...

...

Ngày / tháng / năm / (dd/mm/yyyy):…/…./……

(Ký, ghi rõ họ tên và đóng dấu / Signature and full name, seal of declarant)

II. PHẦN DÀNH CHO HẢI QUAN / FOR CUSTOMS

Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu nhập/ Authentication by Customs officer responsible for examining on of Entry checkpoint

(Ký, đóng dấu công chức / Signature, seal)

Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu xuất / Authentication by Customs officer responsible for examining on of Exit checkpoint:

...

...

...

HẢI QUAN VIỆT NAM / VIETNAM CUSTOMS

HQ/2012-QC

TỜ KHAI HÀNG HÓA QUÁ CẢNH / DECLARATION FOR GOODS IN TRANSIT

(Bản người khai hải quan lưu / for Declarant)

TỔNG CỤC HẢI QUAN / GENERAL
DEPARTMENT OF VIETNAM CUSTOMS

Cục Hải quan/Customs Department: ……………….

Chi cục Hải quan/Sub-Customs Department …….

…………………………………………………………..

...

...

...

Ngày đăng ký / Date of registration:

Số lượng phụ lục tờ khai / Number of Appendix:

…………………………………………………….

…………………………………………………….

Công chức đăng ký / Customs officer responsible for registration: ……………..

(ký, ghi rõ họ tên, đóng dấu công chức / Signature, seal)

A. PHẦN DÀNH CHO NGƯỜI KHAI HẢI QUAN / FOR DECLARANT

1. Người khai hải quan / Declarant:

Tên/Name ………...........................

...

...

...

Địa chỉ / Address: …………............

…………………………………........

Mã số thuế (nếu có)/ Tax code (if any):…………………………..........

2. Người vận chuyển /Transporter(ghi rõ tên / name) …………………………

...........................................................

Địa chỉ/Address: ………………………

………………………………………….

3. Hợp đồng quá cảnh / Conttact for goods in transit:

Số/ No:    …………………………………

...

...

...

Ngày hết hạn/ Expiry date-

d/m/y:…./……/20 ……………………..

…………………………………....………

4. Giấy phép quá cảnh / Permit for goods in transit:

Số/No: …………………………….

Ngày/Date:. …………………......

Ngày hiệu lực / Date of validity: …

……………………………………..

5. Số lượng container / Quantity of container …………………………............

...

...

...

container …………………………………………

………………………………………………………………………………..

……………………………………………………………………………….

6. Địa điểm, thời gian lưu kho / Place, period of storage:..............................

…………………………………....………

…………………………………....………

7. Cảng, địa điểm xếp hàng / Port, Place for loading …………………

……………………………………..

……………………………………..

...

...

...

8. Phương tiện vận tải nhập / Means of transportation of entry: ………………………………

Tên số hiệu/Name of Number sign: ………………..

Ngày đến / date of arrival: ………………………….

………………………………………………………….

9. Vận tải đơn / Bill of Iading / Air way bill ….

……………….............

Số/No: ……...............

Ngày phát hành/ Date of issue: ….........……

10. Cửa khẩu nhập / Entry checkpoint:

...

...

...

……………………

……………………

11. Cửa khẩu xuất/ Exit checkpoint: …….

…………………..

…………………..

…………………..

12. Phương tiện vận tải xuất/ Means of transportation of Exit:

Ngày đi /date of departure: ……

Tên số hiệu/Name of Number sign:

...

...

...

Tuyến đường/line: …………….

……………………………………

Số TT/No

13. Tên hàng, quy cách phẩm chất / Name and description of goods

14. Mã hàng hóa
HS code

15. Xuất xứ
Country of Origin

16. Đơn vị tính Measurement Unit

17. Lượng hàng Quantity

18. Đơn giá nguyên tệ
Unit Price

...

...

...

1

2

...

...

...

3

...

...

...

4

...

...

...

5

...

...

...

Tổng cộng/Total:

20. Chứng từ kèm / attached documents:

- Hợp đồng quá cảnh / Contract for goods in transit: ……………………..

- Bản kê chi tiết / The detail of List ………………………………………….

- Vận tải đơn nhập / Entry Bill of lading ……………………………………

- Giấy phép quá cảnh /Permit for goods in transit  ……………………….

- Khác/other: ………………………………………………………………….

...

...

...

Ngày / tháng / năm / (dd/mm/yyyy): ……./ …../……..
(Ký, ghi rõ họ tên và đóng dấu / Signature, full name and seal of declarant)

B. PHẦN DÀNH CHO HẢI QUAN / FOR CUSTOMS

Ngày xuất / Date of Exit

Tên hàng, quy cách phẩm chất / Name and description of goods

Lượng hàng thực tái xuất/ Exactly quantity to re-export

Lượng hàng còn lại chưa tái xuất/ Quantity of remaining not to re-export

Cửa khẩu xuất / Exit checkpoint

Xác nhận của Chi cục Hải quan Cửa khẩu nhập / Authentication by Sub- Customs Department of Entry checkpoint

Xác nhận của Chi cục Hải quan Cửa khẩu xuất / Authentication by Sub-Customs Department of Exit checkpoint

...

...

...

23

24

25

26

27

28

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

...

29. Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu nhập / Authentication by Customs officer responsible for examining on of Entry checkpoint:

(Ký, đóng dấu công chức / Signature, seal)

...

...

...

(Ký, đóng dấu công chức / Signature, seal)

31. Xác nhận thanh khoản của công chức Hải quan/ Liquidity of Customs officer:

Ngày / tháng / năm/ (dd/mm/yyyy): ……../…./………………………………

(Ký, đóng dấu công chức / Signature, seal)

32. Ô dán tem lệ phí hải quan / Place to stick Customs fees stamp:

...

...

...

HẢI QUAN VIỆT NAM / VIETNAM CUSTOMS

HQ/2012 - PLQC

PHỤ LỤC TỜ KHAI HÀNG HÓA QUÁ CẢNH
APPENDIX DECLARATION FOR GOODS IN TRANSIT

(Bản người khai hải quan lưu / for Declarant)

Phụ lục số / Appendix No:……………………………….

Tờ khai / Declaration No: ………………………….../QC;

Ngày đăng ký/ Date of Registraion: ……………………

I. PHẦN DÀNH CHO NGƯỜI KHAI HẢI QUAN / FOR DECLARANT

...

...

...

Tên hàng, quy cách phẩm chất / Name and description of goods

Mã số hàng hóa
HS code

Xuất xứ
Country of Origin

Đơn vị tính
Measurement Unit

Lượng hàng
Quantity

Đơn giá nguyên tệ
Unit Price

Trị giá nguyên tệ
Value

1

...

...

...

2

...

...

...

3

...

...

...

4

...

...

...

6

...

...

...

7

...

...

...

8

...

...

...

9

...

...

...

Tổng cộng/Total:

...

...

...

Số, ký hiệu Container / No, notation of container   ………………

…………………………………………………………………………

…………………………………………………………………………

………………………………………………………………………..

…………………………………………………………………………

…………………………………………………………………………

Tôi xin cam đoan chịu trách nhiệm trước pháp luật về nội dung khai trên / I hereby declare and shall be responsibte for the above submited information.

Ngày / tháng / năm / (dd/mm/yyyy):…/…./……

(Ký, ghi rõ họ tên và đóng dấu / Signature and full name, seal of declarant)

...

...

...

Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu nhập/ Authentication by Customs officer responsible for examining on of Entry checkpoint

(Ký, đóng dấu công chức / Signature, seal)

Xác nhận của Công chức Hải quan kiểm tra hàng hóa tại cửa khẩu xuất / Authentication by Customs officer responsible for examining on of Exit checkpoint:

(Ký, đóng dấu công chức / Signature, seal)