Annexure-A

EXPORT VALTJE DECLALA.TION

(Scc Rulc 7 ofC.stoms Valuaaion (Detenniration ofValue ofExpo( Goods) Rules'
200'7.\

L Shipping Bil1No. & Da!e:-

2 InvoiceNo. & Date-

3. Nalurc of Transaction

Gift
Sale ! Sale on consig nent Basis

srn,prc ! olrrcr !
4 NletLodofValuxtion
ii"" i'r". , li,",'"" 0",*, RJlc r E Rrrlc 1 ! nutc s ! Rule 6

5. Whcther scller and buyu are rclated Ycs ! *" I

6 U ycs, whclher relalionshi! has influcnced lhc pricc Yes N"!
7 T.turs of Payrnent : Dclivery Piv,nent 90 dav

8. lcFns olDeliv.ry l

9. ?rcvions cxpons olidenlical/ similar goods. ilatrv

Shifping BillNo ed d.t.:

10. Any olhcriel.v.nl lnlomatiotr {A ttach s'Ta'ale sheel. ilte'essrv)

DECLAqAI'ION
and corrcct
1. I/wc hercby declarc thal tbe informalion fumished lbovc is tmc, cornplcte
iD c!,ery rcspect.

2. I/We also underlake to bring to the notice ofpropcr officer any

padculars rvhich
srbs.qrendy collte to my/our knowledgc *hich rvill hlve bearing on avaluation'

Place:

Datc

SICNATURE