| 报检单位(Declaration Inspection Unit) : | * | 
	                        
	                          | 报检単位登记号(Declaration Inspection Unit Register No) : | * | 
	                        
		                        | 收货人(Consignee): | (中文chinese)  * | (外文Foreign Languages)  * | 
	                        
	                          	| 发货人(Consignor): | (中文chinese)  * | (外文Foreign Languages)  * | 
	                        
	                          | 货物名称(中/外文)(Description of Goods): | * | 
	                        
	                          | H.S,编码(H.S Code) : | * | 
	                        
	                          | 原产国(地区)(Country of origin) : | * | 
	                        
	                          | 件/重量(Quantity&Unit Uinal) : | * | 
	                        
	                          | 货物总値(Total Amount) : | * | 
	                        
	                          | 包装种类及数量(Kinds of Packing&Quantity) : | * | 
	                        
	                          | 运输工具名称号码(Conveyance) : |  | 
	                        
	                          | 合同号(Contract Number): |  | 
	                        
	                          | 贸易方式(type of trading ): | * | 
	                        
	                          | 到货日期(Date of Arrival): |  | 
	                        
	                          | 卸毕日期(Date of discharge): |  | 
	                        
	                          | 索赔有效期至(The claim is valid to): |  | 
	                        
	                          | 贸易国别(地区)(Trading Country): | * | 
	                        
	                          | 启运国家(地区)(Destination Country): | * | 
	                        
	                          | 提单/运单号(Bill of lading number ): | * | 
	                        
	                          | 许可证/审批号(License Number): |  | 
	                        
	                          | 集装描规格、裁量及号码 (Container Number):
 |  | 
	                        
	                          | 合同订立的特殊条款以及其他要求 (Special terms and other requirements for the conclusion of the contract) :
 |  | 
	                        
	                          | 入境口岸(Port of entry): | * | 
	                        
	                          | 目的地(Destination): | * | 
	                        
	                          | 货物存放地点(Place of storage): |  | 
	                        
	                          | 用    途(use): |  | 
	                        
	                          | 随附単据划“√”或补填)(Attached Documents): |  | 
	                        
	                          |  | 
	                        
	                          | 标记及号码( Shipping Marks & Remarks Declarant ): |  | 
	                        
	                          | 外商投资财产(划“√”)( property invested by foreign businessmen ): |  | 
	                        
	                          | 检验检疫费总金额(人民市元) (Inspection and quarantine fee):
 |  | 
	                        
	                          | 计费人( Billing person ): |  | 
	                        
	                          | 收费人( Toll collector ): |  | 
	                        
	                        	| 本人被授权报检。上列填写内容正确属实。 Declaration of inspection personnel solemnly:I am authorized to apply for inspection,The above is true and correct。
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	                          | 签名(Signer): |  | 
	                        
	                          | 领取证单(Receive documents) : |  | 
	                        
	                          | 日期(Date): |  | 
	                        
	                          | 签名(Signer) : |  | 
                          	
	                            | 注:有“*''号栏由出入境推验检班机关填写 The content with  * will be writed from Entry-Exit Inspection and quarantine organ
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