INVOICE

DATE OF EXPORTATION EXPORT REFERENCE

SHIPPER/ EXPORTER CONSIGNEE (Complete name & Address)

V.A.T. NO.:

TEL. NO. TEL NO.:

ACCOUNT NO.: SSN/EIN NO. :

TRADE REGISTER NO.: IMPORTER IF OTHER THAN CONSIGNEE

COUNTRY OF EXPORT ________________________

COUNTRY OF ORIGIN OF GOODS

Country of Ultimate Destination FEDEX INTERNATION AWB NO.

Mark/No No. of Complete Description of Goods QTY Unit Total Currency

Packages Value Value

Total No Total Currency

of Pkgs. Value
VALUE DECLARED FOR CUSTOMS PURPOSE ONLY

I DECLARE ALL THE INFORMATION CONTAINED IN THIS INVOICE TO BE TRUE

AND CORRECT.

________________________________________________ _________________
SIGNATURE OF SHIPPER (Name, Title & Signature) DATE

BOMRC 12-16-02 1 OF 1