In the table below, please fill in the complete details of the goods. Include the quantity (units/kg./liters/etc., the manufacturer, model (for electrical appliances), the value in foreign currency, and whether the goods are new or used. Fill in years of use Items such as furniture and electrical appliances must be listed separately.

 

 

Please fill within the limits of the cubes.

If you have several items, please be specific.

E.g 
5 men's shirts - $60  (years of used - 2 years)
3 kids dressers - $40 (years of use - 2 month)
2 books - $30 
1 vitamin - $55

The worth of Value can't be zero, any item must be with some value. 
The years of use  can't be zero or new, any item must be with some value start with 1 year of use

I hereby declare that all the details noted above are correct. I am aware that a false declaration will result in measures being taken according to the law. 

Declaration by entitled persons only:

All goods noted above are for my own personal use or for the use of my family members who reside with me; all other uses or acts including the transfer from my possession before the completion of a period of at least 6 years, shall be with the authorization of the Customs Collector and subject to the conditions set by him.