Import Customs Declaration Form
for Used Machinery
Importer Details
Name of Importer
Importer Address
Contact Number
Email
Consignee Details
Name of Consignee
Consignee Address
Shipment Information
Country of Origin
Country of Supply
Port of Loading
Port of Discharge
Estimated Date of Arrival
Transport Mode
Machinery Details
Description of Machinery
Quantity
Make/Brand
Model
Year of Manufacture
Serial Number(s)
Value (in USD)
Harmonized System Code (HS Code)
Condition of Machinery
Please specify current condition
Any repairs or refurbishments done
Attachments
List attached documents (e.g., Invoice, Packing List, Photos, Certificate of Origin)
Declaration
I hereby declare that the information provided above is true and correct to the best of my knowledge.
Authorized Person’s Name
Signature
Date