Bill of export for Goods under claim for Duty Drawback

 The information provided here is part of Online export import training guide 

Click below to download this form in pdf format:




Invoice No. Date 

SB No. & Date

AR4 No. & Date


Q/Cert. No. & Date

Import Export Code No.

RBI Code No.

Custom House agent Lic. No.

Export Trade Control

In export under:

Deffered Credit ( )

Joint Venture ( )

Rupee Credit ( ) Other ( )

RBIs Approval /Cir. No. &Dt.

Pre-Carriage by

Place of Receipt by Pre Carrier


Type of shippment:

Outright sale ( )

Consignment Export( )

Other ( )

(Specify )

Vessel/Flight no.

Rotation No.

Port of Loading

Nature of Contract: CIF ( ).CFR ( ) FOB ( )

Others (Specify) ( )

Port of Discharge

Country of Destination

Exchange Rate U/S 14 of CA

Currency of Invoice

Marks & Nos.

No. & Kind of Pkgs. Container Nos.

Statistical Code & Description of Goods


Value FOB 

Net Weight

Gross Weight

Total FOB value in words

Analysis of Export Value Currency Amount


Fright _______________________________________________

Insurance _______________________________________________

Commission __________________Rate _________________________

Discount __________________Rate _________________________

Other Discussion __________________Rate _________________________

Full export value OR where not ascertainable, the value which exporter expects to receive on the sale goods

Currency …………………………………………….

Amount …………………………………………….

Sl. No

Eport Tarrif No.

Assessable Value under Sec.14 of CA



Total Duty &









Collection Stamp

Total Duty/CESS amount in words :Rupees


I/We declare that all particulars given herein are true and correct.

I/We also attach the declaration (s) under clause no.(s)………………………………….

Public Notice no. Date Signature of Exporter/CHA—Date

(This Shipping Bill has to be submitted in Quadriplicate - all in green colour) 

The above information is a part of Import Export course online

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