Customs Forms - Form 91 - ATA Carnet form of bill of entry or the shipping bill

GENERAL LIST / LISTE GENERALE

Item no./ d' ordre

Trade description of goods and marks and numbers, if any / designation commerciale des merchandises et, le cas echeant, marques et numeros

Number of Pieces / Nombre de Pieces

Weight or Volume/Poids ou Volume

Value/* Valeur

Country of origin Pays d’ origine

For Customs Use/ No. Reserve a la douane

TOTAL or CARRIED OVER/TOTAL ou A REPORTER

Customs Forms

Forms of ATA carnet ( Bill of Lading and Shipping Bill ) Regulations, 1990
[Refer Notf. No.14/ 90-Cus. (NT), dt.6.4.1990, under Section 46]
INTERNATIONAL GUARANTEE CHAIN				INTERNATIONAL GUARANTEE CHAIN
CHAIN DE GUARANTEE INTERNATIONAL				CHAIN DE GUARANTEE INTERNATIONAL
				ANNEXURE-2
ISSUING ASSOCIATION ASSOCIATION EMETTRICE				ISSUING ASSOCIATION ASSOCIATION EMETTRICE
CARNE DE PASSAGES EN DOUANE POUR'L TEMPORARY ADMISSION
CARNE DE PASSAGES EN DOUANE POUR'L ADMISSION TEMPORARY
CUSTOMS CONVENTION ON THE A.T.A CARNET FOR
TEMPORARY ADMISSION FOR GOODS
CONVENTION DOUANIERE SUR LE CARNET A.TA. POURL' ADMISSION
TEMPORARY DE MARCHANDISES
( Before completing the Carnet, please read Notes at the cover page 3)
Avant the remplir le carnet, lire la notice on page 3 de la couverture)
TO BE RETURNED TO OFFICE OF ISSUE AFTER USE
A. HOLDER AND ADDRESS/				FOR ISSUING ASSOCIATION USE/ titulaire at address reserve at Association emittrice FRONT COVER/ couverture (a)A.T.A.CARNET NO. Carnet A.T.A. No.
B. REPRESENTED BY/				(b) ISSUED BY/ DELIVRE PAR REPRESENTE PAR
C. INTENTED USE/ utilization (inclusive)				(c) VALID UNTIL/ Valuable jusqu' au preview des marchandises ...............\..................\................... Year Monthday anee mois jour (inclus)
The Carnet may be used in following countries under the guarantee of the following Associations: / Ce carnet est valuable dans les pays ci apres, sous la garantee dis associations suivantes:
If applicable/s'ily a leiu
AUSTRALIA (AU) The state chamber of Commerce and Industry, Victoria				COTE DTVOIRE (CI) Chambre de Commerce de la co'te d'lvoire, Abidjan
AUSTRIA (AT) Bundeskammr des gewerblichen wirschaft, Vienna.				CYPRUS Chamber of Commerce and Industry, Nicosia
BELGIUM (BE) Federation National des Chambres de Commerce and Industries de Belgique, Brussels				CZECHOSLOVAKIA (CS) Ceskolovenska Obchondnia prumyslova Komora, Praha
BULGARIA (BG) The Bulgarian Chamber of Commerce and Industry, Sofia				DENMARK (DK) Danish Chamber of Commerce, Copenhagen
CANADA (CA) The Canadian Chamber of Commerce of Finland, Helsinki.				FINLAND (FI) The Central Chamber of commerce of Finland, Helsinki.
FRANCE (FR) Chamber de Commerce at d' Industrie de Paris, Paris				POLAND (PE) Polish Chamber of Foreign Trade, Warsaw
GERMANY (PE) Deutscher Industrie Handlestag, Bonn				PORTUGAL (PT) Associate Commercial de Libson, Libson
GIBRALTOR (GI) Gibraltor Chamber of Commerce, Gibraltor				ROMANIA (RO) Camera de comert si Industry and Republic socialistic Romania, Bucarest
GREECE (GR) The Athens Chamber of Commerce and Industry, Athens				SENEGAL (SN) Chamber de Commerce at d' Industry de la Region de Dakas, Dakas
HONG KONG (HK) The Hong Kong General Chamber of Commerce				SINGAPORE (SG) The Singapore International Chamber de Commerce, Singapore
HUNGARY (HU) Magyar Kereskedelmi Kamara, Budapest				SOUTH AFRICA (ZA) The Association of Chambers of Commerce of South Africa Johanesburg.
ICELAND (IS) Iceland Chamber de Commerce (Verzlunarrad islands) Reykjavik				SPAIN (ES) Consejo superior de las Cameras officiales de comercio Industrial Y Navegacion de Espana, Madrid
IRELAND (IE) The Dublin Chamber of Commerce, Dubin				SRILANKA (LK) Sri Lanka National Council of the International Chamber of Commerce, Colombo
ISRAEL (IL) Tel- Aviv yaffo Chamber of Commerce,Tel-Aviv.				SWEDEN (SE) The Stockholm Chamber of Commerce, Stockholm.
Korea (KR) The Korea Chamber of commerce & Industry, Seoul.				Switzerland (CH) Alliance des chambers de commerce suisses, Ganeva.
Luxemburg (LU) Federation Nationale des chambers de commerce et d' Industries de Belgique, Brussels.				Turkey (TR) Turkey of chambers of commerce, industry, maritime commerce and commodity exchanges of turkey, Ankara.
Mauritius (MU) The Mauritius Chamber of commerce and Industry, Port Louis.				United Kingdom (GB) The London Chamber of Commerce & Industry, London.
Netherlands (nl) Kamer van Koophandel en Fabrieken voor’s-Gravenhage, The Hague.				United states of America (us) U.S. Council for international business, newyork.
New Zealand (NZ) Oslo chamber of commerce, Oslo.				Yugoslavia (YU) The Yugoslavia Federal Economic Chamber, Belgrade.
Norway (NO) Oslo chamber of commerce, Oslo.
The holder of this carnet and his representative will be held responsible for compliance with the laws and regulations of the country of departure and the countries of importation / A change pour le titulaire et son representant de se conformer aux lois et reglements du depart et des pays d’importation.
Certificate of Customs authorities/ Attestation des autorities douanieres
a) Identification marks have been affixed as indicated in column 7 against the following item No(s) of the General List/Appose’ les marques d’identification mentionne es dans la colonne 7 en regard du (des) nume’ro(s) d’ordre suivant(s) de la liste generale. ……………………………….. …………………………………………..				Signature of Authorised Official and Stamp of the issuing Association / Signature du delegue et timbre de’ Association e’ mettrice
b) Goods examined/Verifies les merchandises Yes / Qui ... No/Non ........…..				Place and date of issue (year/month/day) Lieu et date d’emission (annee/mois/jour)
c) Registered under reference no./……………… Enregisre sous le numero				Signature of holder / signature du titulaire
d) ……………. …………….. ……………….. Customs Place Date (year/ Signature Office month/day) and Stamp Bureau de Lieu Date (annee/ Signature Douane mois/jour) et Timbre
Identification marks have been affixed as indicated in column 7 against the following items No(s) of the General List: / Appose les marques d’identification mentionees dans la colonne 7, en regard du(des) numero(s) d’ordre suivants (s) de la liste generale: ................................................................................................................................................................... .................................................................................................................................................................
Customs office place date (year/month/day) Signature and stamp Bereau de douane lieu date (annee/mois/jour) Signature et Timbre
Identification marks have been affixed as indicated in column 7 against the following items no(s) of the General List:/Appose les marques d’identification mentionnees dans la colonne 7, en regard de(des) numero (s) d’ ordre suivant (s) de la liste generale: ............................................................................................................................................................ ............................................................................................................................................................
……………. …………….. ……………….. Customs Office Place Date (year/month/day) Signature and Stamp Bureau de Lieu Date (annee/mois/jour) Signature et Timbre Douane
General list /liste generale
Item no./ no. d’ order	Trade description of goods and marks and numbers, if any / Designation commerciale des merchandises et, le cas echeant, marques et numeros	Number of Pieces / Nombre de Pieces	Weight or volume/ poids ou volume		Value/* valeur Origin /	Country of origin / pays d’origine	For customs use/reserve a la douane
1	2	3	4		5	6	7

Total or carried over/ Total ou A reporter
Commercial value in country of issue and in its currency, unless stated differently/ Valeur commerciale dans le pays d’emission et dans mannaie, sauf indication contraire.
Show country of origin if different from country of issue of the Carnet, using ISO country codes./ Indiquer le pays d’ origine s’il est different pays d’emission du carnet, eu utilisant le code international des pays ISO.
Exportation counterfoil no. A.T.A Carnet No. Souche d’ exportation no. Carnet A.T.A. No. 1. The goods described in the General List under Item No. (s) ………………. Les merchandises enumerees a la liste generale sous le(s) no. (s)..................................................... have been exported. ont ete exportees
2. Final date for duty-free re-importation/ Year / Month / day date limite pour la reimportation en / franchise annee / mois / jour
3. Other remarks* / Autres mentions* .................................................... ....................................................

Customs Office

Bureau de

Place

Date (year/month/day)

Signature and Stamp

If applicable / sily a lieu

A. HOLDER AND ADDRESS / Titulaire et adresse

FOR ISSUING ASSOCIATION USE/

Reserve a l’ Association emettrice

G. EXPORTATION VOUCHER NO.

Volet d’ exportation no.

a) A.T.A. CARNET NO……………..

camet A.T.A. no.

B. REPRESENTED BY*/

Represent par*

b) ISSUED BY / deliver par

C. INTENDED USE OF GOODS

Utilisation prevue des marchandises

c) VALID UNTIL / valuable

Jusqu’au

D. MEANS OF TRANSPORT*/moyens de transport

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a

a) The goods referred to in the above declaration have been exported / Les merchandises faisant ‘’object de la declaration ci-contre ont ete exportees

b) Final date for duty-free re-importation / date limite pour la re-importation en franchise

…………./……………../……………………….

Year Month Day

Annee mois jour

c) This voucher must be forwarded to the Customs office at*/Le present volet dvra etre transmis au bureau de douane de*:

……………………………………..

d) Other remarks*:/Autres mentions*:

At / A……………………………….

At / A…………………….

Customs office / Bureau de douane

………/………./………. ………………….

Date (Year/month/day) Signature and stamp

Date (annee/mois/jour) Signature et Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

*Commercial value in country of issue and in its currency, unless stated differently/* Valeur commerciale dans le pays d’emission et dans sa monnaie, sauf indication contraire.

**Show country of origin if different from country of issue of the carnet, using ISO country codes./ ** Indiquer le pays d’ origine s’il est different du pays demission du carnet, en utilisant le code international des pays ISO.

RE-IMPORTATION COUNTER FOIL NO. A.T.A. CARNET NO.

SOUCHE DEREIMPORTATION NO. CARNET A.T.A. NO.

1. The goods described in the General List under Item No. (s)………

Les merchandises enumerees a la liste generale sous le(s) No. (s)

..................................................................................................................................

which were temporarily exported under cover of exportation voucher(s) No. (s) ……….. of this Carnet have been re-imported / exportees temporarement sous le couvert du (des) volet(s) d’ exportation No.(s) du present carnet ont ete reimportees.

2 . Other remarks*/Autres mentions* .............

....................................................................

.......................

Customs office

Bureau de douane

.........

Place

Lieu

.........../........./...............

Date (Year/month/day)

Date (annee/mois/jour)

..........................................

Signature and Stamp

Signature et Timbre

*If applicable / Sil y a lieu

HOLDER AND ADDRESS / Titulaire et adresse

FOR ISSUING ASSOCIATION USE/

Reserve a l’ Association emettrice

G. EXPORTATION VOUCHER NO.

Volet d’ exportation no.

a) A.T.A. CARNET NO……………..

camet A.T.A. no.

B. REPRESENTED BY*/

Represent par*

b) ISSUED BY / deliver par

C. INTENDED USE OF GOODS

Utilisation prevue des marchandises

c) VALID UNTIL / valuable

Jusqu’au

........../......... /...............

Date Year / month/ day (Inclusive)

Date annee / mois / jour (Inclus)

D. MEANS OF TRANSPORT*/moyens de transport

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a l'a reimportation

a) The goods referred to in the declaration have been paragraph

F. a) and b) of the holder's reimported / Les marchandises vises aux paragraph F a) et b) de la declaration ci-contre ont ete reimportees

b) This voucher must be forwarded to the Customs Office at*/Le present volet dvra etre transmis au bureau de douane de*:

……………………………………..

d) Other remarks*:/Autres mentions*:

At / A…………………….

Customs office / Bureau de douane

………/………./………. ………………….

Date (Year/month/day) Signature and

stamp

Date (annee/mois/jour) Signature et

Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

*Commercial value in country of issue and in its currency, unless stated differently/* Valeur commerciale dans le pays d’emission et dans sa monnaie, sauf indication contraire.

RE-IMPORTATION COUNTER FOIL NO. A.T.A. CARNET NO.

SOUCHE DEREIMPORTATION NO. CARNET A.T.A. NO.

1. The goods described in the General List under Item No. (s)……… Les merchandises enumerees a la liste generale sous le(s) No. (s) .................................................................................................................................. which were temporarily exported under cover of exportation voucher(s) No. (s) ……….. of this Carnet have been re-imported / exportees temporarement sous le couvert du (des) volet(s) d’ exportation No.(s) du present carnet ont ete reimportees.
2. Final date for re-exportation / production to the Customs of goods/ Date limite pour la reexportation la re-representation a la douane des merchandises	Year / Month / day annee/ mois / jour
3. Registered under reference no.* / Enregistre sous le No.*.................................
4. Other remarks/ Autres mentions....... ............................................................ ............................................................

....................

Customs Office

Bureau de

........

Place

......../......../......

Date (year/month/day)

..............................

Signature and Stamp

Signature et Timbre

*If applicable / Sil a lieu

HOLDER AND ADDRESS / Titulaire et adresse

a) A.T.A. CARNET NO……………..

camet A.T.A. no.

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a

a) The goods referred to in the above declaration have been temporarily imported / Les merchandises faisant I' objet de la declaration ci-contre ont ete exportees

b) Final date for re-importation / production to the customs*:

…………./……………../……………………….

Year Month Day

Annee mois jour

c) Registered under reference no.*/

Enregistre sous le No.

d) Other remarks*:/Autres mentions*:

At / A……………………………….

Customs office / Bureau de douane

………/………./……….

Date (Year/month/day) Signature and stamp

Date (annee/mois/jour) Signature et Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

B. REPRESENTED BY*/

Represent par*

b) ISSUED BY / deliver par

C. INTENDED USE OF GOODS

Utilisation prevue des marchandises

c) VALID UNTIL / valuable

Jusqu’au

........../......... /...............

Date Year / month/ day (Inclusive)

Date annee / mois / jour (Inclus)

D. MEANS OF TRANSPORT*/moyens de transport

E. Package details (Number, Kind, Marks etc.)*/Details d' emballage (nombre, nature, marques etc.)*

F. temporary importation /

declaration

Declaration d' importation temporaire

I, duty authorised: / Je soussigne, dument autorise

a) Declare that I am temporarily importing in compliance with the conditions laid down in the laws and regulations of the country of importation, the goods enumerated in the list overleaf and described in the General list under item no. (s) / declare importer temporairement, dans les conditions prevues par les lois et reglements du pays d' importation, les marchandises enumerees a la liste figurant au verso et reprises a la liste generale sous le(s) No. (s)

................................

b) Declare that the said goods are intended for use at / declare que les marchandise sont destinees a etre utilisees a .............................

c) Undertake to comply with these laws and regulations and to re-export the said goods within the period stipulated by the customs office or regularize their status in accordance with the laws and regulations of the country of importation.

/ m 'engage a observer ces lois et reglements et a reexporter ces marchandises dans les delais fixes par le bureau de douane ou a regulariser leur situation selan les lois et reglements du pays d' importation.

d) Confirm that the information given is true and complete./ certificate sinceres et completes les indications protees sur le present volet.

Signature X................................................

Signature

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a l'a reimportation

a) The goods referred to in the declaration have been temporarily imported / Les marchandises faisant l' objet de la declaration ci-contre ont ete importees temporairement.

b) Final date for re-exportation / production to the customs*: / Date limite pour la re-exportation 'la representation a la douane des marchandises*:

………/………./……….

(Year/month/day)

(annee/mois/jour)

……………………………………..

d) Other remarks*:/Autres mentions*:

At / A…………………….

Customs office / Bureau de douane

………/………./………. ………………….

Date (Year/month/day) Signature and stamp

Date (annee/mois/jour) Signature et Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

*Commercial value in country of issue and in its currency, unless stated differently/* Valeur commerciale dans le pays d’emission et dans sa monnaie, sauf indication contraire.

RE-IMPORTATION COUNTER FOIL NO. A.T.A. CARNET NO.

SOUCHE DEREIMPORTATION NO. CARNET A.T.A. NO.

1. The goods described in the General List under Item No. (s)………Les merchandises enumerees a la liste generale sous le(s) No. (s) .................................................................................................................................. Temporarily imported under cover of importation voucher (s) Nos (s) …………………… Importees temporairement sous le couvert du (des) volet (s) d ‘importation No. (s) of this carnet have been re-exported* / du present carnet ont ete re/exportees’
2. Action taken in respect of goods not produced but not re-exported..............Measures prises a l’egard des merchandises representees mais non re/exportees
3. Action taken in respect of goods not produced and not intended for later re-exportation* / Mesures prises a l’egard des merchandises non representees at non destinees a une re-exportation ultereure*
4. Registered under reference No.* / Enregistre sous le. No.*...........

....................

Customs Office

Bureau de

........

Place

......../......../......

Date (year/month/day)

..............................

Signature and Stamp

Signature et Timbre

HOLDER AND ADDRESS / Titulaire et adresse

a) A.T.A. CARNET NO……………..

camet A.T.A. no.

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a

a) The goods referred to in the above declaration have been temporarily imported / Les merchandises faisant I' objet de la declaration ci-contre ont ete exportees

b) Final date for re-importation / production to the customs*:

…………./……………../……………………….

Year Month Day

Annee mois jour

c) Registered under reference no.*/

Enregistre sous le No.

d) Other remarks*:/Autres mentions*:

At / A……………………………….

Customs office / Bureau de douane

………/………./……….

Date (Year/month/day) Signature and stamp

Date (annee/mois/jour) Signature et Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

B. REPRESENTED BY*/

Represent par*

b) ISSUED BY / deliver par

C. INTENDED USE OF GOODS

Utilisation prevue des marchandises

c) VALID UNTIL / valuable

Jusqu’au

........../......... /...............

Date Year / month/ day (Inclusive)

Date annee / mois / jour (Inclus)

D. MEANS OF TRANSPORT*/moyens de transport

E. Package details (Number, Kind, Marks etc.)*/Details d' emballage (nombre, nature, marques etc.)*

F. re-EXPORTATION /

declaration

Declaration d' importation temporaire

I, duty authorised: / Je soussigne, dument autorise

................................

b) Declare that goods produced against the following item no (s) are not intended for re-exportation: declare que les merchandises representees et reprises sours le (s) No. (s) suivant (s) ne sont pas destinees a la re-exportation:

.................................

c) Declare that goods of the following item no. (s) not produced, are not intended for later re-exportation: declare que les merchandises non representees et reprises sous le (s) No. (s) suivant (s) ne seront pas re-exportees ulterieurement:

d) In support of this declaration present the following documents/presente a l’ appui de mes declarations, les documents suivants:

e) Confirm that the information given is true and complete./ certificate sinceres et completes les indications protees sur le present volet.

Signature X................................................

Signature

FOR CUSTOMS USE ONLY / reserve a la Douane

H. CLEARANCE ON EXPORTATION /

dedouanement a l'a reimportation

a) The goods referred to in the declaration have been temporarily imported / Les marchandises faisant l' objet de la declaration ci-contre ont ete importees temporairement.

b) Final date for re-exportation / production to the customs*: / Date limite pour la re-exportation 'la representation a la douane des marchandises*:

………/………./……….

(Year/month/day)

(annee/mois/jour)

……………………………………..

d) Other remarks*:/Autres mentions*:

At / A…………………….

Customs office / Bureau de douane

………/………./………. ………………….

Date (Year/month/day) Signature and stamp

Date (annee/mois/jour) Signature et Timbre

Place.......... Date (Year/month/day)

Lieu Date (annee/mois/jour)

Name…………………..

Nom

Signature X………………………X

Signature

*Commercial value in country of issue and in its currency, unless stated differently/* Valeur commerciale dans le pays d’emission et dans sa monnaie, sauf indication contraire.