DECLARATION TYPE (1)

EUROPEAN UNION MRN

Consignor/Exporter (2) 23346346346 Other SCI (S32)

CONSIGNOR123 T2F
12-65 Forms (3) Sec. Decl. (S00)
CITY1 1 3
TRANSIT/SECURITY ACCOMPANYING DOCUMENT

3456
AT Items (5) Total packages (6) Gross mass (kg) (35)
8 4161 1000.55
Consignee (8) 3464567575 Reference number (7)

CONSIGNEE444 21LVNCTSDEC21081001
345 Return copy has to be sent to the office:
CITY2
0987
NL

Date and time of arrival at first place of arrival in Customs territory (S12) C. disp./exp. Code(15) Country destin. Code (17)
2021-08-10T08:00:00.000Z LV NL
Transport charges method of payment code (S29) Other incidents during carriage Details and CERTIFICATION BY COMPETENT AUTHORITIES (G)

B measures taken (56)

Identity and nationality of means of transport at departure (18)
4354554 DE
Identity and nationality of active means of transport crossing the border (21)
44444444 DE
Mode of transport at the Location of goods (30)
1 LOCATION HH AT

Place of loading (S17) Place of unloading (S18) Countr(ies) of routing codes (S13)
CN
Conveyance reference number (S10) AT

Consignee (security) (S06) No Consignor (security) (S04) No

Tester001
TERMINAL INTERMODAL
3434
DUDELANGE
LU

Carrier (S07) No Seal Number (S28)

TESTER 1234 2345 3456

Ramalayam
Narsapur 4567
534275
IN

Transhipments Place and country: Place and country:

(55)
Ident. and nat. new means transp.: Ident. and nat. new means transp.:

Ctr. (1) Identity of new container: Ctr. (1) Identity of new container:

(1) Enter 1 if YES and 0 if NO. (1) Enter 1 if YES and 0 if NO.

CERTIFICATIO New seals Number: identity: New seals Number: identity:

N BY
COMPETENT
Signature: Stamp: Signature: Stamp:
AUTHORITIES
(F)

Data already recorded into the system

Data already recorded into the system

Principal/TIR Holder (50) OFFICE OF DEPARTURE (C)

PRINCIPAL
12-87 LV000123
CITY5 3456
LV

Intended offices
of transit (and
28/08/2019 HAMBOURG
country) (51)

TRA3234352
Guarantee not valid for (52) 1 LV007677677 Code Office of destination (and country) (53)
7654 LV76676 (LV)
CONTROL BY OFFICE OF DEPARTURE (D) CONTROL BY OFFICE OF DESTINATION (I)
Results: Satisfactory Date of arrival: Return copy sent
Seals affixed: Number: 4 on
Examination of seals:
1234 2345 3456 After registration under
identity:
4567 No
Time limit (date): 20190829 Remarks: Signature: Stamp:
 MRN

TRANSIT/SECURITY LIST OF ITEMS Forms (3)

2 3
Item No Number and kind of packages, pieces, marks and numbers of packages (31/1) Description of goods (31/2)
Consignor/Exporter (2) Consignee (8)
Consignor (security) (S04) Consignee (security) (S06)
Produced documents / certificates (44/1) Summary declaration / Previous document (40)
Special mentions (44/2)
Identity and nationality of means of transport at departure (18) Unique consignment reference number (7)
Identity and nationality of active means of transport crossing the border (21) Container numbers (31/3) Seal Number (S28)
Place of unloading (S18) Commodity Code (33) Gross mass (kg) (35)
UNDG (44/4) Sensitive Quantity (31/5) Sensitive Code (31/4) Tpt.Ch.M.Pay.code (S29) Declaration type (1) C.disp/exp.Code (15) C.Dest.Code (17) Net mass (kg) (38)

1 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254

2 2 500 124246 15 desc1

2325345 QRWER 25436 AT 23534643 GDSDFGH NL

45 WRTT WRASGFSD 345 QRWETTEW ADDD

4354554 AT 21LVNCTSDEC21081001

44444444 DE 235346 1234 2345

CN 23535573 2500.366

23 235435 B T2F AT CN 234345

3 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254

4 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001
44444444 DE 23534634 12345 1234 2345
CN 7896555 1000.55

1 12 B T1 CN AG 34254

5 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254

6 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254
 MRN

TRANSIT/SECURITY LIST OF ITEMS Forms (3)

3 3
Item No Number and kind of packages, pieces, marks and numbers of packages (31/1) Description of goods (31/2)
Consignor/Exporter (2) Consignee (8)
Consignor (security) (S04) Consignee (security) (S06)
Produced documents / certificates (44/1) Summary declaration / Previous document (40)
Special mentions (44/2)
Identity and nationality of means of transport at departure (18) Unique consignment reference number (7)
Identity and nationality of active means of transport crossing the border (21) Container numbers (31/3) Seal Number (S28)
Place of unloading (S18) Commodity Code (33) Gross mass (kg) (35)
UNDG (44/4) Sensitive Quantity (31/5) Sensitive Code (31/4) Tpt.Ch.M.Pay.code (S29) Declaration type (1) C.disp/exp.Code (15) C.Dest.Code (17) Net mass (kg) (38)

7 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254

8 AB 500 34545 GOODDESC

CONO_1234567 Consignor Name Consignor Street Consignor City 123456 AE CONE_1234567 Consignee Name Consignee Street Consignee City 234567 AG
CONO_SEC_1234567 Consignor Security Name Consignor Security Street Consignor Security City CONE_SEC_1234567 Consignee Security Name Consignee Security Street Consignee Security City
2 REF_2_1234 Add_Info_2_1234 CO REFDOC PD_Additional Info I1
WERWT DG1 true IS

4354554 AT 21LVNCTSDEC21081001

44444444 DE 23534634 12345 1234 2345

CN 7896555 1000.55

1 12 B T1 CN AG 34254