SHIPPER'S LETTER OF INSTRUCTIONS

SHIPPER'S LETTER OF INSTRUCTIONS
1a. EXPORTER (Name and address including ZIP CODE)
b. EXPORTER'S EIN (IRS) NO.
c. PARTIES TO TRANSACTION

RelatedUnrelated
2. DATE OF EXPORT

MonthDayYear
Date
3. BILL OF LADING/ AIR WAYBILL NO.
4a. ULTIMATE CONSIGNEE
b. INTERMEDIATE CONSIGNEE
SHIPPER'S REFERENCE
5. FORWARDING AGENT
6. POINT (STATE) OF ORIGIN OR FTZ NO.
7. COUNTRY OF ULTIMATE DESTINATION
8. LOADING PIER
9. MODE OF TRANSPORT (SPECIFY)
10. EXPORTING CARRIER
11. PORT OF EXPORT
12. PORT OF UNLOADING (VESSEL AND AIR ONLY)
13. CONTAINERIZED (VESSEL ONLY)

YesNo
SHIPPER MUST CHECK

PREPAIDAIRDIRECTCOLLECTCOD $OCEANGROUNDCONSOLIDATE
SHIPPER'S INSTRUCTIONS IN CASE OF INABILITY TO DELIVER AS CONSIGNED

RETURN TO SHIPPERABANDONDELIVER TO:
14. SHIPPER REQUESTS INSURANCE

YesNo
AMOUNT $
SCHEDULE B DESCRIPTION OF COMMODITIES (USE ITEMS 17-19)
15. MARKS AND NOS. AND KINDS OF PACKAGES
DESCRIPTION OF COMMODITIES*
SHIPPER'S NOTE:

IF YOU ARE UNCERTAIN OF THE SCHEDULE B COMMODITY NO. DO NOT TYPE IT IN - WE WILL COMPLETE WHEN PROCESSING.
WE HAVE FORWARDED TO YOU THE SHIPMENT DESCRIBED BELOW VIA:

YOUR TRUCKOTHER CARRIER
TRUCK LINE NAME
RECEIPT (PRO) NUMBER
VALUE (U.S. DOLLARS, OMIT CENTS) (SELLING PRICE OR COST IF NOT SOLD)
21. VALIDATED LICENSE NO./GENERAL LICENSE SYMBOL

MonthDayYear
Date
22. ECCN (When Required)
24. I certify that all statements made and all information herein are true and correct and that I have read and understand the instructions for preparation of this document, set forth in the "Correct Way to Fill Out the Shipper's Export Declaration." I understand that civil and criminal penalties, including forfeiture and sale, may be imposed for making false or fraudulent statements herein, failing to provide the requested information or for violations of U.S. laws on exportation (13 U.S.C. Sec. 305; 22 U.S.C Sec. 401; 18 U.S.C. Sec. 1001; 50 U.S.C. App 2410).*

Certify
Signature*

Clear
Title
Date*

MonthDayYear
Date
DOCUMENTS ENCLOSED

Cancelof
SPECIAL INSTRUCTIONS
CONFIDENTIAL - For use solely for official purposes authorized by the Secretary of Commerce (13 U.S.C. 301 (g)).

Export Shipments are subject to inspection by U.S. Customs Service and/or Office of Export Enforcement.

NOTE: The Shipper or his authorized agent hereby authorizes the above named Company, in his name and on his behalf, to prepare any export documents, to sign and accept any documents relating to said shipment and forward this shipment in accordance with the conditions of carriage and the tariffs of the carriers employed. The shipper guarantees payment of all collect charges in the event the consigned refuses payment. Hereunder the sole responsibility of the Company is to use reasonable care in the selection of carriers, forwarders, agents and others to whom it may entrust the shipment.

Shipper's Letter of Instruction.PDF (08/11)
Should be Empty:

SHIPPER'S LETTER OF INSTRUCTIONS

SHIPPER'S NOTE: