APPLICATION FOR IMPORT COMMODITY CLEARANCE
(Please submit one copy)

The Regional Director
Bureau of Product Standards
Department of Trade and Industry
Region VII, Cebu City

Sir :

        In accordance with Section 6 of Republic Act 4109 and in conjunction with Letter of Instruction No. 1208 and the Memorandum re: Mandatory Philippine National Standards, we hereby apply for an Import Commodity Clearance of our incoming shipment.

1. Name of Applicant Firm	:
2. Office Address / Tel. No.	:
3. Warehouse Address / Tel. No.	:
4. Product Imported	:
5. Brand Name	:
6. Type/Capacity/Grade	:
7. Quality/Volume of Import	:
8. Value of Import	:
9. Country of Origin	:
10. Name of Exporter	:
11. Address of Exporter	:
12. Port of Discharge	:
13. Vessel / Air Carrier	:
14. Voyage / Flight No.	:
15. Import Entry No.	:
16. Bill of Lading / Airway Bill No.	:
17. Name of Duly Authorized Rep.	:
18. Position of Duly Authorized Rep.	:
19. Address and Tel. No. Duly Authorized Rep	:

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________________________________
Printed Name & Signature of Importer /
Authorized Representative of Importer

              Subscribed and sworn to before me this 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st of January February March April May June July August September October November December , 20 00 01 02 03 04 05 06 07 08 09 10 affliant exhibiting to me his/her Residence Certificate A/B No. _______________ issued at _________________________________ on________________, 1999

 

 

________________________________
Notary Public                          

 

 

Doc No. ________
Page No. _______
Book No. _______
Series of 1999