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1. INSPECTION EXPORTER'S DECLARATION Name and address of Manufacturer: We declare these goods to be of ................................ origin 10 17 (attached list for more than 1 origin) We, the undersigned, declare that a commission has been 18 granted to: (Name /address/P.O. Box/in the country of importation) Contact name: calculated on basis of: Teleph.: Telefax: EX- WORKS / FOB / CFR / CIF %: amounting to: Name and full address of place of inspection : 11 PRICE BREAKDOWN Currency: 19 EX -WORKS ................................ : Person to contact: Packing........................................ : Teleph.: Telefax: Cost to FOB ................................ : Total FOB ................................ : Foreseen date of inspection: 12 Insurance..................................... : Ancillary charges......................... : Delivery: Total: Partial: 13 Freight.......................................... : Number of foreseen shipments: 14 o o TOTAL: FOB / CFR / CIF: Container: FCL Consolidated 15 Place where the container will be stuffed: 16 Stamp and signature of 21 exporter: FOR BUREAU VERITAS USE ONLY Name: 20 INSPECTION RESULT: Date: PRICE VERIFICATION: o o No Date : Sign. SATISFACTORY : Yes B U R E A U REQUEST FOR INSPECTION 2 V E R I T A S CONTACT NAME: DATE: Address of Centre of Relations with Exporters 1 3 EXPORTER: TELEFAX: TELEPH.: YOUR EXPORT TO: Telefax: Teleph.: YOUR PRO FORMA INVOICE: DATE: BUREAU VERITAS REFERENCE: IMPORT DOCUMENT REF.: 4 6 IMPORTER: VALIDITY DATE: 5 7 8 DESCRIPTION OF THE GOODS: If you intend to ship goods free of charge, please give the list and their values: 9 IMPORTANT - PLEASE READ CAREFULLY This inspection and verification is conducted on behalf, and under extant rules or regulations, of the Government of the importing country. As such the BV Group has no liability towards the buyer, seller or shipper. The scope of the BV Group intervention is in accordance with the World Trade Organisation Agreement on Pre-Shipment Inspection. The BV Group General Terms and Conditions of service are available upon request. This inspection does not relieve the buyer, seller or shipper to any commercial or contractual agreements. To assist us in the performance of the preliminary valuation verification, you are requested to send to the relevant BV Group office the following documents : - Pro-forma invoice - Export Price List - Technical specification- catalogue - Certificates of Quality or Analysis - Copy of Letter of Credit (if applicable) In order to organize the inspection, please provide a minimum of 2 days notice for inspection. The physical inspection report is valid for 1 month for perishable goods and 3 months for all other consignments. Re-inspection, for whatever reason, shall be chargeable to the exporter. For multiple shipments, please copy this form and advise for each shipment. To complete the process, we shall require the final documents (Final invoice and shipping documents, if necessary). These should be sent to this office as soon as possible. Please quote the BV reference number with all correspondence. To provide the best service, you are requested to complete the following information in full.