TMI BlogApplication for Export Original/Duplicate/Triplicate/Quadruplicate/QuintuplicateX X X X Extracts X X X X X X X X Extracts X X X X ..... (Place) to.........................................................................(Place)....................................................(Foreign territory).............................. Columns to be filled in by the Columns to be filled in by the Exporter Land Customs Officer <!--?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /--> No. and Description of packages Identifying Marks and Nos. Description of the goods. Govt. Stores/Private Merchandise Item No. and trade description of goods ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... .. Total value..................(in words) Tariff value (if any) ................................ (in words) ............................................... Total duty (in words) .............................. Total real value........................................ (in words) ............................................... Total Cess (in words) ............................. N.B. - In cases in which more than one unit of quantity is indicated in the fourth column (the column under the heading particulars ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ........... Amount Rupees.................... (in words) . Date of payment ...... Signature of tenderer CERTIFICATE OF PAYMENT .. . Received Payment of Rs...................... (in words)........................... (Signature of owner or his authorised Agent) (Signature of owner or his authorised Agent) (Signature of Land Customs Officer at Land Customs Station) ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... according to the Indian Trade Classification issued by the Department of Commercial Intelligence and Statistics, Calcutta. Real value of goods F.O.B. value of goods Tariff value, if any Real value of goods on which duty ad valorem is leviable Customs duty No. and particulars of Import licence, if any. Export Remarks Rate per unit or quantity. Total Rate Total Rate Total Rate Total 1 2 ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... true . An amount of Rs as Customs Duty and Rs . As cess assessed. (in words) (Signature with full name and address of Exporter or his agent) (Signature of Land Customs Officer at Land Customs Station) . Date . STATEMENT OF DUTY CESS PAID (To be filled in by Exporter or his Agent) PERMIT PAYMENT IN CASH Payment through Account-current Payment by Money Order Treasury/Sub-Treasury/ Reserve Bank of India/State Bank of India....... Title of Account or Ledger No..... ..... X X X X Extracts X X X X X X X X Extracts X X X X
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