Date:  Shipment Date

Your Company Name
Street Address
City
Postal Code
Country

Your Name
Telephone No.
 

Centro de Servicios TransFresh Global Ltda.
Attention: SHIPPING AND RECEIVING
Avenida Presidente Eduardo Frei Montalva 9950-1 Modulo B-3,
Quilicura, Santiago de Chile
Chile

Phone: 011 56-2 246 1266 extension 2028

Full Description of Goods

No of Units

Unit Weight

Weight (kg)

Unit Value (US$)

Value (US$)

TransFresh Marine CA Controllers (Commodity Code 9032.89.00) 

9801 U.S. GOODS RETURNED 

12

3.0kg (6.5lb)

 36

$360.15

 $4321.80

Country of Origin:               USA

Total Weight:   36

Total Value:   $4321.80

 No of Packages:                3

 FedEx Air Waybill No:    9999 8888 77776

NOTE: NO COMMERCIAL VALUE - Goods Not for Resale

Goods are for use in marine shipping containers for perishable fruits and vegetables. Being returned to owners.

I certify that the information on this declaration is true and correct to the best of my knowledge.
 

Name:   Print Your Name                             Signature:___Sign Here ________