REPUBLIC OF KENYA
No
KENYA REVENUE AUTHORITY
Customs services Departement
IMPORT DECLARATION FORM
Importer Name & Address PIN
Contact Name
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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
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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
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