Client Reference Entry Type Entry Number
Payment Method (Drawback)
Exporter/Licensee Code Agent Code
Customs Controlled Area Code Declarants Code
Country of Destination
Deposit (Refund) Process Indicator
Sold/Consignment
COMPLETION OF SIGHT/TEMPORARY ENTRY PERMIT INFORMATION OTHER INFORMATION
Original Entry Number
Authority Number Code Data
Remarks
SHIPPING DETAILS
Mode of Transport Voyage No. Craft/Flight Date of Export Total Gross Weight
(kg)
Sea / Air / Mail
Port of Loading Port of Discharge
Delivery Authority Code
CONTAINER AND PACKAGE INFORMATION
Number & Type of Packages Container Number Container Status Bill Number Bill Type
DETAIL LINE INFORMATION
Detail Line No. Description of Goods Tariff Item
Country of Origin
Statistical Unit Statistical Quantity Supplementary Unit Supplementary Quantity
FOB
(Whole NZ$)
Exchange Rate Indicator Currency Code Exchange Rate FOB
(Foreign)
Misc. Reason Code Misc. Amount
NZ$
Drawback Duty
NZ$
Drawback GST
NZ$
Total Drawback
NZ$
PERMIT INFORMATION PROHIBITED GOODS OTHER INFORMATION
Authority Number Code Code Data
ENTRY TOTAL
Total Drawback
NZ$
I .................................................................................................................. Exporter/Agent of Exporter
declare that the particulars contained in this entry are true and correct
.................................................................................................... .........................................
Signature Date
1
Form C5
EXPORT ENTRY
* An Export Entry Transaction Fee is payable when making this entry.
