Export Declaration Form

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....p;(Specify)....... AD code: IE Code: GSTIN: PAN: AD Name & Address: Exporters Name & Address: Mode of Realisation : [ ] L/C [ ] BG [ ] Others (advance payment, etc. including transfer/remittance to bank a/c maintained overseas ) Consignee Name & Address: Port of Loading / Source Port in case of SEZ : Third Party name & Address (In case of third Party Payments for Exports) ....

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....p;   Discount     Other Deduction     Packing Charges     Full export value / Net Realisable export value     2B. Details of Export Value^ of Services Details of services provided to multiple recipients S. No Service recipient Name & Address Country Details of Invoice Net Realisable value Contract No., if any, and&nb....

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....e true and that the value to be received from the buyer/third party represents the export value^ contracted and declared above. I/We undertake that I/we have delivered/ will deliver to the authorised dealer named above the foreign exchange / Indian Rupees representing the full value of the goods/services exported as above on or before........................ (i.e. within the period of realisation ....