| Company Name: | |
| Address: | |
| Contact Person: | |
| Mobile: | |
| Tel: | 
| Company Name: | |
| Address: | |
| Contact Person: | |
| Mobile: | |
| Tel: | 
| Cargo Information: | Goods Number: | ||
| Packaging of goods: | Goods weight: | ||
| In-kind value: | Cargo volume: | 
| Mode of transport: | Delivery: | ||
| Payment: | The receipt and: | ||
| Pick up: | Yes No | Consignment instructions: | 
| Payment: | Consignor to pay (pay) Consignee to pay (to pay) |