1. SHIPPING BILL NO & DATE : _____________________________________
2. INVOICE NO & DATE : _____________________________________
3. NATURE OF TRANSATION :

   SALE      ✓	GIFT
   SAMPLE	OTHER

4. METHOD OF VALUTION : RULE 3     RULE 4 ✓ RULE 5    RULE 6    
   (SEA EXPORT VALUATION RULES)
5. WHEATHER SELLER & BUYER ARE RELATED : YES     NO ✓
6. IF YES, WHEATHER RELATIONSHIP HAS INFLUANCED THE PRICE : YES     NO    
7. TERMS OF PAYMENT : _____________________________________
8. TERMS OF DELIVERY : _____________________________________
9. PREVIOUS EXPORTS OF IDENTIFY SIMILAR GOODS IF ANY :
10. ANY OTHER RELEVANT INFORMATION :
    (ATTATCH SEPARATE SHEET IF NECCESARY)

1. I/WE HEREBY DECLARE THAT THE INFORMATION FURNISED ABOVE IS COMPLETE & CORRECT IN EVERY ASPECT.
2. I/WE ALSO UNDERTAKE TO BRING TO THE ADVICE OF PROPER OFFICER ANY PARTICULARS WHICH SUBSEQUANTLY COME TO MY OBLIGE OR KNOWLEDGE WHICH WILL HAVE BEARING ON A VALUATTION.