FORM E11
[see Rule 27]
Statement from clearing, forwarding, transporting, shipping
Agent/Agency etc.
Name and address of the clearing forwarding house, transporting agent / shipping agent or steamer agent ..................... etc......... the periods to which the return relates .................
Sl. No.
Date of clearing forwarding transporting shipping etc.
Name and full address of the consignor.
Name and full address of the consignee.
Number & date of delivery note/bill of lading /RR etc. No. date
1
2
3
4
5
Description of scheduled goods
Quantity
Value of goods
Remarks
No. of Packing
Weight
6
7
8
9
10
DECLARATION
I/We .......................... declare that to the best of my/our knowledge that the information furnished in the above return is true and correct and that it relates to the period of ............
Name and signature with
Status of the person signing