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INFORMATION

Name and/ or Company:

Address:

City:

State:

Tel:

Fax:

E-mail:

CONSIGNEE'S INFORMATION

Name and/ or Company:

Address:

Country:

Tel:

Fax:

CARGO INFORMATION

Commodity:

Number of Pieces:

Total Weight in Kilos:

Total Value:

  Insurance: Yes No

If Yes-Declared Value for Insurance:

Final Destination:

Port of Loading:

Port of Discharge:

Pick-up Date:and time:

Dimension and weight of each piece (If any):

Does shipment include any restricted and/ or dangerous explosives,radioactive supstances, dry ice, flammable compressed gases, perishables, live animals, etc?
Yes No

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