Declaration by Exporter

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..... f which this declaration is made and that the particulars given in the Shipping Bill No. ....................... dated ...................... are true and that (a) * the value as contracted with the buyer is the same as the full export value declared in the above shipping bill (b) * the full export value of the goods is not ascertainable at the time of export and that the value declared is that wh .....

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..... the date of shipment but for exports to warehouses established outside India with permission of the Reserve Bank, the date of delivery must be within fifteen months. * Strike out whichever is not applicable. FOR AUTHORISED DEALER'S USE Uniform Code Number ...................... * Indicate ( ) in the box applicable Date of (i) negotiation............................ .....

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..... (Currency amount) Date of receipt Currency Credit to Nostro Account _________ in (Country) Debit to NR Rupee Account of a Bank in _____________ (Country) Period .....

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..... ** Write the name of the concerned Indian Authorised Dealer Branch. Any other manner of receipt (Specify) ................................................................................................ __________________________________________ (Stamp Signature of authorised dealer) Date: .......... .....

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