DOCK RECEIPT
2. EXPORTER (Principal or seller-license and address including ZIP 5. DOCUMENT NUMBER 5A. B/L OR AWB NUMBER
Code)
ZIP CODE
3. CONSIGNED TO 7. FORWARDING AGENT (Name and address – references)
8. POINT (STATE) OF ORIGIN OR FTZ NUMBER
4. NOTIFY PARTY/INTERMEDIATE CONSIGNEE (Name and address) 9. DOMESTIC ROUTING/EXPORT INSTRUCTIONS
12. PRE-CARRIAGE BY 13. PLACE OF RECEIPT BY PRE-CARRIER
14. EXPORTING CARRIER 15. PORT OF LOADING/EXPORT 10. LOADING PIER/TERMINAL
16. FOREIGN PORT OF UNLOADING (Vessel 17. PLACE OF DELIVERY BY ON- 11. TYPE OF MOVE 11.a CONTAINERIZED (Vessel only)
and air only) CARRIER
MARKS AND NUMBERS NUMBER DESCRIPTION OF COMMODITIES in Schedule B detail GROSS WEIGHT MEASUREMENT
OF PACKAGES (Kilos)
(18) (19) (20) (21) (22)
Vehicle must be delivered to exporting carrier before
presentation of the documents to Customs. Compliance is
mandatory. Carriers and exporters are liable for penalties
set forth in 19CFR 192 Export Control.
RECEIVED THE ABOVE DESCRIBED GOODS OR PACKAGES SUBJECT TO ALL
THE TERMS OF THE UNDERSIGNED REGULAR FORM OF DOCK RECEIPT AND
BILL OF LADING WHICH SHALL CONSTITUTE THE CONTRACT UNDER WHICH
THE GOODS ARE RECEIVED. COPIES OF WHICH ARE AVAILABLE FROM THE
CARRIER ON REQUEST AND MAY BE INSPECTED AT ANY OF ITS OFFICES.
FOR THE MASTER
RECEIVING CLERK:_________________________________ DATE:________________________________