Export Declaration Form for Used Electronics
Exporter Information
Exporter Name
Address
Contact Number
Consignee Information
Consignee Name
Address
Contact Number
Shipment Details
Country of Destination
Port of Loading
Port of Discharge
Date of Export
Used Electronics Details
Description
Quantity
Make/Model
Serial Number
Condition
Declaration
I hereby declare that the above stated information is true and correct to the best of my knowledge and that the used electronics being exported are not deemed hazardous under relevant regulations.
Name of Signatory
Position
Date
Signature