SHIPPER`S LETTER OF INSTRUCTIONS

1a. EXPORTER (Name and address including ZIP code)

SHIPPER: PLEASE BE SURE TO COM-
PLETE ALL SHADED AREAS.
ZIP CODE

b. EXPORTER`S EIN (IRS) NO. c. PARTIES TO MTRANSACTION

 Related  Non-related
4a. ULTIMATE CONSIGNEE

b. INTERMEDIATE CONSIGNEE

5. FORWARDING AGENT

6. POINT (STATE) OF ORIGIN OR FTZ N O 7. COUNTRY OF ULTIMATE DESTINATION

8. LOADING PIER (Vessel only) 9. MODE of TRANSPORT

(Specify)
SHIPPER MUST CHECK
 PREPAID  COLLECT C.O.D. $ ___________________
10. EXPORTING CARRIER 11. PORT OF EXPORT
 AIR  OCEAN  CONSOLIDATE  DIRECT
SHIPPER`S INSTRUCTIONS IN CASE OF INABILITY TO DELIVER CONSIGNMENT
12. PORT OF UNLOADING (Vessel 13. CONTAINERIZED (Vessel only)
and air only) AS ASSIGNET  ABANDON  RETURN TO SHIPPER
 Yes  No
 DELIVER TO
SHIPPER REQUESTS
INSURANCE  No  Yes $
14. SCHEDULE B DESCRIPTION OF COMMODITIES SHIPPER´S REF. NO. DATE
- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -
15. MARKS, NOS., AND KINDS OF PACKAGES
 (Use columns 17-19) VALUE
(U.S. dollars, omit cents)
(Selling price or cost if not
D/F SCHEDULE B NUMBER CHECK QUANTITY – SHIPPING sold)

(16) (17) DIGIT Schedule B Unit (s) WEIGHT (kg)

(18) (19) (20)

SHIPPERS NOTE:
IF YOU ARE UNCERTAIN OF THE
SCHEDULE B COM-MODITY NO. DO
NOT TYPE IT IN – WE WILL
COMPLETE WHEN PROCESSING
THE 7525V.

WE HAVE FORWARDED TO YOU, THE

SHIPMENT DESCRIBED BE-LOW VIA:
 YOUR TRUCK, OR
 OTHER CARRIER
(LISTED BELOW)
TRUCK LINE NAME ______________
___________________________________
RECEIPT (PRO) NUMBER ________
___________________________________

DECLARED VALUE FOR

CARRIAGE
$
21. VALIDATED LICENSE NO./GENERAL LICENSE SYMBOL 22. ECCN (When required)
PLEASE SIGN THE FIRST EXPORT DECLA-RATION IN
BOX 23 WITH PEN AND INK.
23. Duly authorized officer or employee The exporter authorizes the forwarder DOCUMENTS ENCLOSED:
named above to act as forwarding agent
for export control and customs
purposes.
24. I certify that all statements made and all information contained herein are
true and correct and that I have read and understand the instructions for
preparation of this document, set forth in the „CORRECT WAY TO FILL OUT
THE SHIPPER`S EXPORT DECLARATION:“ I understand that civil and
criminal penalties, including forfeiture and sale, may be imposed for making
false or fraudulent statements herein, falling to provide the requested
information or for violation of U.S. laws on exportation (13 U.S.C. Sec. 305; 22
U.S.C. Sec. 401; 18 U.S.C. Sec. 1001; 50 U.S.C. App. 2410).

SIGNATURE CONFIDENTIAL – For use solely for SPECIAL INSTRUCTIONS:

official puposes authorized by the Secre-
tary of Commerce (13 U.S.C. 301 (g)).
Value listed is reportable amount for SED
TITLE Export shipments are subject to
inspection by U.S. Customs Service Please notify _____________ if there are any problems with this shipment.
and/or Office of Export Enforcement. Phone: Fax: E-Mail:
DATE 25. AUTHENTICATION (When required)

NOTE: The shipper of his Authorized Agent hereby authorizes the above named Company, in his name and on behalf, to prepare any export documents, to sign and
accept any documents relating to said shipment and forward this shipment in accordance with the conditions of carriage and the tariffs of the carriers
employed. The shipper guarantees payment of all collect charges in the event the consignee refuses payment. Hereunder the sole responsibility of the Company
is to use reasonable care in the selection of carriers, forwarders, agents and others to whom it may entrust the shipment.