| Shippers Name & Address: | |
| Consignee Name & Address: | |
| Notify Party: | |
| Mode of Transport: | Air Sea |
| ECN Number: | |
| Special Instructions: | |
| Does this shipment contain dangerous goods? | Yes No |
| Currency: | |
| Weight & Valuation Charges: | Pre-Paid Collect |
| All other Charges: | Pre-Paid Collect |
| Declared Value for carriage: | |
| Declared Value for Customs: | |
| No of Pieces RCP: | |
| Gross Weight: | |
| KG or LBS: | KGS LBS |
| Rate Class: | |
| Comodity No: | |
| Chargable Weight: | |
| Rate / Charge: | |
| Nature and Quantity of Goods (INC. Dimension of Volume) |
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