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Importing into the United States - Indo-American Chamber Of ...

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PRO FORMA INVOICE<br />

Importers Statement of Value or <strong>the</strong> Price Paid in <strong>the</strong> Form of an Invoice<br />

Not being in possession of a special or commercial seller’s or shipper’s invoice I request that you accept <strong>the</strong> statement<br />

of value or <strong>the</strong> price paid in <strong>the</strong> form of an invoice submitted below:<br />

Name of shipper ___________________________ address _________________________________<br />

Name of seller _____________________________ address _________________________________<br />

Name of consignee _________________________ address _________________________________<br />

Name of purchaser _________________________ address _________________________________<br />

The merchandise (has) (has not) been purchased or agreed to be purchased by me. The prices, or in <strong>the</strong><br />

case of consigned goods <strong>the</strong> values, given below are true and correct to <strong>the</strong> best of my knowledge and<br />

belief, and are based upon (check basis with an “X”):<br />

(a) The prices paid or agreed to be paid ( ) as per<br />

order dated _______________________<br />

(b) Advices from exporters by letter ( ) by cable<br />

( ) dated _______________________<br />

(c)<br />

Comparative values of shipments previously<br />

received ( ) dated _______________<br />

(d) Knowledge of <strong>the</strong> market in <strong>the</strong> country of<br />

exportation ( )<br />

(e) Knowledge of <strong>the</strong> market in <strong>the</strong> <strong>United</strong> <strong>States</strong><br />

(if U.S. value) ( )<br />

(f) Advices of <strong>the</strong> Port Director of Customs ( )<br />

(g) O<strong>the</strong>r ( )<br />

A B C D E F G<br />

Case Manufacturer’s Quantities and full description Unit Total Unit Total<br />

markes item number purchase purchase foreign foreign<br />

numbers symbol or brand price price value value<br />

(currency)<br />

(currency)<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

________________________________________________________________________________________________<br />

Check which of <strong>the</strong> charges below are, and which are not, included in <strong>the</strong> prices listed in columns “D” and “E”:<br />

Amount Included Not Included Amount Included Not Included<br />

Packing ______________________________________<br />

Cartage ______________________________________<br />

Inland Freight _________________________________<br />

Wharfage and loading<br />

abroad __________________________________<br />

Country of origin ______________________________<br />

Lighterage ___________________________________<br />

Ocean Freight ________________________________<br />

U.S. duties ___________________________________<br />

O<strong>the</strong>r charges (identify by<br />

name and amount ________________________<br />

Total _________________________________________<br />

If any o<strong>the</strong>r invoice is received, I will immediately file it with <strong>the</strong> Post Director.<br />

Date __________<br />

Signature of person making invoice _____________________<br />

Title and firm name ___________________<br />

A-2 U.S. CUSTOMS SERVICE

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