| Exporter Name 1 | |
| Exporter Address 1 | |
| Consignee Name 2 | |
| Consignee Address 2 | |
| Consignee Country 2 | |
| Transport Details 4 | |
| Country of Origin 3 | |
| Place and Date of Issue 8 | / |
| Marks, numbers, number and kind of packages, description of goods 6 | Quantity 7 |
|---|---|
| INVOICE NO : | |