REPUBLIC OF KENYA No KENYA REVENUE AUTHORITY Customs services Departement IMPORT DECLARATION FORM Importer Name & Address PIN Contact Name ce Telephone Fax / Telex ler’s Name & Address ‘Contact Name Pail Telephone Fax / Telex County oF Sippy Pon of Discharge (Kenya) Port of Customs Clearance | Mee of Transport ETD Local Inspection (Y/N) COMESA ‘Origin Centficate References Transactions Terms Inv No & Date (ddemin’yy) | Ineotemn Ors ow Currency Exchange Rate FOR Value Frcight Insurance “Other Charges Wow ised Uaicot Full description and applicable standards Origin Hs Code Quant FOR value (year) PP ns} i | quantity TOTAL Dearne Tar eae Fe TAT Ta Ta TF RTS RTP, wT eT eT TS vat ~ O ~ oO cary wo »~ a AM ws O ~ a Ow ow