BOX 1 - Declaration BOX 36 - Preference
BOX 2 - Exporter/Suppliers Address BOX 37 - Procedure
BOX 3 - Page BOX 38 - Item Net Weight
BOX 4 - Place NA BOX 39 - Valuation
BOX 5 - Item BOX 40 A - AWB/Bill of Lading
BOX 6 - Total Packages BOX 40 B - Previous Document No.
BOX 7 - Reference Number BOX 41 - Supplementary Units
BOX 8 - Importer, Consignee BOX 42 - Item Customs Value
BOX 9 - Freight, Insurance OC Respectively BOX 43 - Valuation Method
BOX 10 - Place NA BOX 44 - Additional Information, Documents Submitted,
BOX 11 - Place NA Certificates/Authorization
BOX 12 - Place NA BOX 45 - Adjustment
BOX 13 - Tentative Release Code BOX 46 - Dutiable Value
BOX 14 - Broker, Atty-In-Fact BOX 47 - Calculation of Taxes
BOX 15 A - Country of Exporter BOX 48 - Prepaid Account No.
BOX 15 B - Country of Exporter Code BOX 49 - Identification of Warehouse
BOX 16 - Country of Origin BOX 50 A - Signature & Name of the Importer and the
Broker or the Importer's Atty-In-Fact as well as the date
BOX 17 - Country of Destination BOX 50 B - Subscription and Sworn
BOX 18 - Vessel/Aircraft BOX 51 - Authorization
BOX 19 - Container BOX 52 - Control at Office of the Destinantion (Reverse
BOX 20 - Terms of Delivery Side)
BOX 21 - Local Carrier BOX 53 - Internal Revenue Taxes
BOX 22 - Foreign Currency BOX 54 - Section of the FED responsible for processing
the entry
BOX 23 - Exchange Rate BOX 55 - No. of Pacakges Examined
BOX 24 - Thru Bank BOX 56 - Date Received
BOX 25 - Date BOX 57 - Date Released
BOX 26 - Place NA BOX 58 - Description un Tariff Terms (Revised Charges)
BOX 27 - Transshipment Port BOX 59 - Charges
BOX 28 - Financial & Ranking Date BOX 60 - (as per) Declaration
BOX 29 - Port of Destinantion BOX 61 - (as per) Findings
BOX 30 - Location of Goods BOX 62 - Difference
BOX 31 - Marks and Numbers, Packages, Container #(s), BOX 63 - Action directed/recommended date, COO V
Number and Kind
BOX 32 - Item Number BOX 64 - Date, COO III Liquidation
BOX 33 - HS Code (Commodity Code) BOX 65 - Liquidation Amount (php)
BOX 34 A - Country of Origin Code BOX 66 - Shortages/Excess (php)
BOX 34 B - Place NA BOX 67 - Remarks
BOX 35 - Item Gross Weight (kg) BOX 68 - Prepaid Account No.
BOX 69 - Identification of Warehouse