Shipper Letter Form – Fill Out and Use

SHIPPER'S LETTER OF INSTRUCTIONS

b. EXPORTER'S EIN (IRS) NO.

c. PARTIES TO TRANSACTION

2. DATE OF

3. BILL OF LADING/ AIR WAYBILL NO.

Related

Unrelated

EXPORT

4a. ULTIMATE CONSIGNEE

SHIPPER'S REFERENCE

5. FORWARDING AGENT

6. POINT (STATE) OF ORIGIN OR FTZ NO.

7. COUNTRY OF ULTIMATE DESTINATION

8. LOADING PIER

(Vessel only)

9. MODE OF TRANSPORT

(Specify)

SHIPPER MUST CHECK

PREPAID

AIR

DIRECT

10. EXPORTING CARRIER

11. PORT OF EXPORT

COLLECT

OCEAN

CONSOLIDATE

COD $

GROUND

12. PORT OF UNLOADING (Vessel and air only)

13. CONTAINERIZED (Vessel only)

Yes

No

SHIPPER'S INSTRUCTIONS IN CASE OF INABILITY TO DELIVER AS CONSIGNED:

14. SHIPPER REQUESTS INSURANCE

ABANDON

RETURN TO SHIPPER

Yes

No

AMOUNT: $

DELIVER TO:

SCHEDULE B DESCRIPTION OF COMMODITIES

} (Use Columns 17-19)

SHIPPER'S NOTE:

VALU E (U.S. dollars,

15. MARKS AND NOS. AND KINDS OF PACKAGES

IF YOU ARE UNCERTAIN OF THE

omit cents)

SCHEDULE B COMMODITY NO.

(Selling price or cost

D/F

SCHEDULE B NUMBER

CHECK

QUANTITY

SHIPPING WEIGHT

DO NOT TYPE IT IN - WE WILL

if not sold)

DIGIT

SCHEDULE B UNITS

(Kilos)

COMPLETE WHEN PROCESSING.

(20)

(16)

(17)

(18)

(19)

WE HAVE FORWARDED TO YOU

THE SHIPMENT DESCRIBED

BELOW VIA:

YOUR TRUCK

OTHER CARRIER

(LISTED BELOW)

TRUCK LINE NAME:

RECEIPT (PRO)

NUMBER:

21. VALIDATED LICENSE NO./GENERAL LICENSE SYMBOL

22. ECCN (When required)

PLEASE SIGN THE FIRST EXPORT DECLARATION IN BOX 23

WITH PEN AND INK

23. Duly authorized officer or

The exporter

authorizes

the forwarder

named

DOCUMENTS

ENCLOSED

employee

above to act as forwarding agent for export control

and customs purposes.

24. I certify that all statements made and all information contained herein are true and correct and that I have read and

understand the instructions for preparation of this document, set forth in the "Correct Way to Fill Out the Shipper's

Export Declaration." I understand that civil and criminal penalties, including forfeiture and sale, may be imposed for

making false or fraudulent statements herein, failing to provide the requested information or for violation of U.S.

laws on exportation (13 U.S.C. Sec. 305; 22 U.S.C. Sec. 401; 18 U.S.C. Sec. 1001; 50 U.S.C. App. 2410).

Signature

Confidential - For

use solely for

official

SPECIAL INSTRUCTIONS

purposes authorized by the Secretary of

Commerce (13 U.S.C. 301 (g)).

Title

Export Shipments are subject to inspection

by U. S. Customs Service and/or Office of

Export Enforcement.

Date