FORM - C - COURIER BILL OF ENTRY – XII (CBE-XII) FOR SAMPLES AND GIFTS - Courier Imports and Exports (Electronic Declaration and Processing) Regulations, 2010

FORM - C [see regulation 5(3)] COURIER BILL OF ENTRY XII (CBE-XII) FOR SAMPLES AND GIFTS (Electronic Filing) S. No. Description Details 1. Courier Registration Number 2. Name and address of the Authorized Courier 3. Name of the airlines 4. Airport of arrival 5. First port of arrival, wherever applicable. 6. Flight No. 7. Date of arrival 8. Time of arrival 9. Airport of shipment 10. Country of exportation 11(i) . HAWB No. 11(ii). CRN No., if applicable. 12. Unique Consignment reference No. 13. Name and address of the consignor 14. Name and address of the consignee 15. IEC Code 16. IEC Branch Code 17. No. of items included in HAWB 18. Item-wise Details: CTH Nature of shipment (Gifts / Samples) Country of origin Description of goods Name address of manufacturer (I) (II) (III) (IV) (V) Item-wise Details (continued): No. of packages Marks and number of packages, wherever applicable Unit of measure Quantity Invoice No. (VI) (VII) (VIII) (IX) (X) Item-wise Details (continued): No. of packages Marks and number of packages, wherever applicable Unit of measure Quantity Invoice No. (VI) (VII) (VIII) (IX) (X) DECLARATION I / we declare that the authorization from each of the consignees or consignors relating to the above mentioned consignments have been obtained by me / us to act as an agent for the clearance of the goods. I / We hereby declare that goods imported as per this Bill of Entry include only bonafide commercial samples, prototypes of goods and bonafide gifts of articles for personal use of value not exceeding Rs.Ten thousand and which are for the time being not subject to any prohibition or restriction on their import into India. I / We enclose herewith________(number) of Airway bills and _________ (Number) of Invoices for the aforesaid consignments with this Bill of Entry. I / we hereby declare that the contents of this Bill of Entry are complete, correct and true, in every respect and are in accordance with the airway bills, the invoices and other documents attached herewith. Date: Signature and name of the authorised courier Place: NOTE: Uploading images of HAWB and invoices shall be optional in CBE-XII while filing through bulk upload or otherwise. ***