SHIPPER

D/R NO.

抬头

CONSIGNEE

缴纳出口货物港务费申请书

NOTIFY PARTY

第五联副页

PRE-CARRIAGE BY             PLACE OF RECEIPT

OCEAN VESSEL  VOY.NO.    PORT OF LOADING

PORT OF DISCHARGE  PLACE OF DELIVERY

FINAL DESTINATION FOR THE MERCHANT'S RETER-ENCE

CONTAINER NO.

SEAL NO.

NO. OF CONTAINERS OR PKGS

KIND OF PACKAGES: DESCRIPTION OF GOODS

GROSS WEIGHT

MEASUREMENT

TOTAL NUMBER OF CONTAINERS OR PACKAGES (IN WORDS))

SAY ____________________ONLY

CONTAINER NO.

SEAL NO.

PKGS

CONTAINER NO.   SEAL NO.  PKGS

RECEIVED 
              BY 
TERMINAL

FREIGHT & CHARGE

PREPAID AT

PAYABLE AT

PLACE OF ISSUE

TOTAL PREPAID

NO. OF ORIGINAL B/L THREE