Name of Owner           ID No. of Owner             Purpose (Official/Private)
  物品批文号         电话       进/出境     进出境口岸
Permit No. of Article      Telephone      Entry/Exit       Entry/Exit Port
  起运/运抵国(地区)              装货/指运港
Departure/Destination Country(Region)           Port of Loading/Delivery
  运输方式(水路 铁路 公路 航空 邮件 其它)    运输工具名称      航次(班)号
Means of Transport: (water rail road air mail other)Carrier’s Name        Voyage/Flight No.
  提运单号         件数        毛重(千克)     备注
Bill of Lading No.       Number of Piece(s)   Gross Weight (kg)   Remarks
  以下内容可由受托方填写
The following may be completed by the party entrusted
| 进/出境日期      年  月  日 包装种类        体积      标箱数 Date of Entry/Exit Year  Month  Date  Type of Package       Volume      Number of TEU    内包装件数            受托方名称及海关代码(身份证件号码) Quantity of Inside Packages      Agency/Agent and Customs Code/ID No.                    | 
  本人(机构)申请进/出境下列公用/自用物品,并保证所有申报属实。
We, the undersigned organization, hereby apply for the import/export of the following articles for personal use or for official use and guarantee that all our declaration is true.
| 项号 Item No. | 物品税号 Tariff Code | 物品名称 Descriptions  | 规格/型号 Speci./ Model | 数量 Quantity | 单位 Unit | 币制 Currency  | 总价 Total Value  | 备注 Remarks | 
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| 馆长、机构负责人签名 Signature of Head of the Diplomatic Mission/Organization  馆印、机构印鉴 Seal of Mission/Organization 申报日期        年  月  日 Date of Declaration Year  Month  Date   附   页    Pages Attached | 海关批注 Customs Remarks  海关签章 Customs Seal |