S.L. 365.13 Art. 11Quantity of the items Customs export procedure 16. 17. I hereby declare that all Signature FOR OFFICE Export Signature Name in Date * Technical Note: Boxes Note: In part deducted on that 17. Net unit with 18. In 1. 2. 1. 2. 1. 2. 1. 2. 1. 2.

Currency and Value 12.

13 End use 14. Contract date 15.

Additional information deemed relevant by the exporter apply for an export authorization in respect of the item described above and I the particulars furnished by me are correct.

Name in blocks Date USE ONLY Reference No: authorized: This authorization is valid until:

Stamp blocks specifications of the item should be attached to this application form 1 to 17 should all be filled. A separate form should be submitted for each item.

I of box 18, enter the quantity still available, and in part 2 of box 18 enter the quantity occasion. quantity/value (Net mass/other 20. Customs document 21. Name in blocks indication of unit) (Type and number and signature or extract number) of Customs numbers 19. In words and date of Officer and for deduction stamp quantity/ value deducted

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