08 November 2012
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RANGE ...………………………........................................... DIVISION …………...................................………………… COMMISSIONERATE ………................................................…………...………………………………………………............ C.No. Date Shipping Bill No.* Date
EXAMINATION REPORT FOR FACTORY SEALED PACKAGES/CONTAINER:
1. Name of Exporter :
2. a) IEC No. : b) Branch Code : c) BIN (PAN based Business Identification Number of the exporter :
3. Name of the manufacturer (if different from the exporter) :
4. Factory address :
5. Date of examination :
6. Name & designation of the examining officer-Inspector/EO/PO :
7. Name & designation of the supervising officer-Appraiser/Superintendent :
8. (a) Name of Commissionerate/Division/Range : (b) Location Code** :
9. Particulars of export Invoice (a) Export Invoice No. : (b) Total No. of packages : (c) Name and address of the consignee abroad :
10. (a) Is the description of the goods, the quantity and their value as per particulars furnished in the export invoice? : : Yes/No
(b) Whether sample is drawn for being forwarded to Port of export? : Yes/No
(c) If yes, the number of the seal of the package containing the sample :
11. Central Excise/Customs Seal Nos. (a) For Non-containeraised cargo Seal Nos. No. of packages : (b) For Containerised Cargo Container Number Size Seal No. No. of Packages stuffed in container (1)
(2) (3) (4)
SIGNATURE OF EXPORTER SIGNATURE OF INSPECTOR/EXAMINER SIGNATURE OF APPRAISER/ SUPERINTENDENT NAME___________________________ NAME_________________________ NAME________________________ DESIGNATION____________________ DESIGNATION __________________ DESIGNATION _________________
STAMP
STAMP
STAMP
Note:
Invoice(s) and any other document accompanying this document should be attested by the officer supervising the examination.
*To be filled in by the exporter before filing of this document at the time goods registration" in the export shed.
**Revised 6 digit code as assigned by the Directorate of S&I, XXYYZZ
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