CLEAN CERTIFICATE OF INSPECTION

EXPORTERS DECLARATION
1. NXR form No 2. NEPC No 3. YEAR
4. H. S. Code 5. ORIGIN 6. DATE
7. EXPORTERS NAME AND ADDRESS 8. IMPORTERS NAME AND ADDRESS

9. RC No:
10. EXPORTERS BANK - NAME AND ADDRESS 11. IMPORTERS BANK - NAME AND ADDRESS

12. BANK REFERENCE 13. BANK REFERENCE

14. GOODS TO BE EXPORTED
15. UNITS
16. QUANTITY
17. UNIT PRICE
18. EXPORTER'S INVOICE No 19. INVOICE DATE
20. BASIS OF SALE – FOB/ C&F/ CIF
21. METHOD OF PAYMENT
22. CURRENCY
23. EXPORTERS FOB INVOICE VALUE (FIGS)
24. FRIEGHT CHARGES (FIGS)
25. INSURANCE CHARGES (FIGS)
26. TOTAL INVOICE VALUE (FIGS)
DECLARED SHIPPING DETAILS
27. SHIPMENT DATE 27B. SHIPPING AGENT
28. CARRIER / VESSEL 28B. LOADING REF NO
29. PORT / POINT OF EXPORT 30. DESTINATION
31. CONTAINER NUMBERS
PRESHIPMENT INSPECTION FINDINGS
32. H.S CODE
33. GOODS TO BE EXPORTED
34. UNITS 34B. INSPECTION DATE
35. QUANTITY
36. UNIT PRICE
37. PARKING DETAILS 37B. GROSS WEIGHT
38. QUALITY 38B. NET WEIGHT
39. TOTAL FOB VALUE OF GOODS (FIGS)
40. TOTAL FOB VALUE OF GO0DS (words):
41. TOTAL FRIEGHT CHARGES (FIGS)
42. TOTAL INSURANCE CHARGES (FIGS)
43. BASIS OF SALE FOB/C&F/CIF
44. FOREX PROCEEDS BASED ON TRANSACTION (FIGS)
45. EXCHANGE DATE 46. CURRENCY
47. RATE OF EXCHANGE
48. NESS CHARGES PAID ON NXP FORM 49. RECEIPT NO.
50. ACTUAL NESS CHARGES PAYABLE
51. BALANCE PAID 52. RECEIPT NO.
REPRESENTATIVE