Form C5
EXPORT ENTRY
Client Reference
Entry Type
Entry Number
Payment Method (Drawback)
Exporter/Licensee
Code
Customs Controlled Area
Code
Agent
Code
Declarants Code
Country of Destination
Deposit (Refund)
I .................................................................................................................. Exporter/Agent of Exporter
declare that the particulars contained in this entry are true and correct
Process Indicator
Sold/Consignment
....................................................................................................
Signature
.........................................
Date
COMPLETION OF SIGHT/TEMPORARY ENTRY
PERMIT INFORMATION
OTHER INFORMATION
Original Entry Number
Authority
Code
Number
Data
Remarks
SHIPPING DETAILS
Mode of Transport
Voyage No.
Craft/Flight
Date of Export
Total Gross Weight (kg)
Sea / Air / Mail
Port of Loading
Port of Discharge
Delivery Authority
Code
CONTAINER AND PACKAGE INFORMATION
Number & Type of Packages
Container Number
Container Status Bill Number
Bill Type
DETAIL LINE INFORMATION
Detail Line No.
Description of Goods
Tariff Item
1
Country of Origin
Statistical Unit
FOB (Whole NZ$)
Misc. Reason Code
Statistical Quantity
Supplementary Unit
Exchange Rate Indicator
Misc. Amount NZ$
Supplementary Quantity
Currency Code Exchange Rate
Drawback Duty NZ$
FOB (Foreign)
Drawback GST NZ$
Total Drawback NZ$
PERMIT INFORMATION
PROHIBITED GOODS
OTHER INFORMATION
Authority
Code
Code
Number
Data
ENTRY TOTAL
Total Drawback NZ$
* An Export Entry Transaction Fee is payable when making this entry.