CUSTOMS May be Opened

Officially
CN22
DECLARATION
INDIA POST IMPORTANT: See instructions
on the back
Gift Commercial Sample

Documents  Other Tick one or more boxes

Quantity and detailed description Weight (in kg) Value (3)

Of Contents(1)
1. Aleos Socotrina 30M (1 Bott. Pills) 0.055 Rs. 200.00
2. Cicuta Virosa 6M (1 Bott. Pills) 0.055 Rs. 150.00
3. Bellis Per 6M (1 Bott. Pills) 0.055 Rs. 223.00
4. Ratanhai 30M (1 Bott. Pills) 0.055 Rs. 177.00
5. Gelsemium 30 (1 Bott. Pills) 0.055 Rs. 165.00
6. Ruta 6M (1 Bott. Pills) 0.055 Rs. 180.00
7. Symphytum 6M (1 Bott. Pills) 0.055 Rs. 105.00

For commercial items only if known, Total Weight Total

HS tariff number (4) and country of origin of goods (5) (in kg) Value (7)
India 0.385 Rs. 1200.00
I, the undersigned, whose name and address are given on the item, certify that the particulars given in this declaration are
correct and that this item does not contain any dangerous article or articles prohibited by legislation or by postal or customs
regulations.

Date: 20/04/2016 Senders Signature (8)

For all articles value less than Rs.23000/-

INSTRUCTIONS

To accelerate customs clearance, fill this form in English, French or in a language accepted by the destination country. If the
value of the contents is over 300SDR, you must use a CN 23 form. You must give the sender’s full name and address on the front
of the item.

(1) Give a detailed description, quantity and unit measure of each article, e.g. 2 men’s cotton shirts, especially of articles subject
to quarantine (plant, animal, food products etc.).

(2) , (3), (6) and (7) Give the weight and value of each article and the total weight and value of the item. Indicate the currency
used e.g. CHF for Swiss francs.

(3) and (5) The HS tariff number (6-degit) must be based on the Harmonized Commodity Description and Coding System
developed by the World Customs Organization. Country of origin means where the goods originated, e.g. were produced,
manufactured or assembled. It is recommended you supply this information and attach an invoice to the outside as this will
assist Customs in processing the items.

(8) Your signature and date confirm your liability for the item.

300 SDR = Rs. 23000 – Value of SDR may change. Please confirm before filling the form
CUSTOMS May be Opened
Officially
CN22
DECLARATION
INDIA POST IMPORTANT: See instructions
on the back
 Gift Commercial Sample

Documents Other Tick one or more boxes

Quantity and detailed description Weight (in kg) Value (3)

Of Contents(1)
1. Three Tiered Feng Shui Tortises (size: 12x8x10cm) Qty: 1 0.375 Rs. 799.00
2. Rose Quartz Pencil Pendant with Cap. (stone) Qty: 1 0.032 Rs. 250.00

For commercial items only if known, Total Weight Total

HS tariff number (4) and country of origin of goods (5) (in kg) Value (7)
India 0.385 Rs. 1049.00
CUSTOMS May be Opened
Officially
CN22
DECLARATION
INDIA POST IMPORTANT: See instructions
on the back
Gift Commercial Sample

Documents  Other Tick one or more boxes

Quantity and detailed description Weight (in kg) Value (3)

Of Contents(1)
1. Aleos Socotrina 30M (1 Bott. Pills) 0.055 Rs. 200.00
2. Belladona 30M (1 Bott. Pills) 0.055 Rs. 150.00
3. Argentinum Nitricum 30M (1 Bott. Pills) 0.055 Rs. 223.00
4. Colchicum 30M (1 Bott. Pills) 0.055 Rs. 177.00
5. Gelsemium 30 (1 Bott. Pills) 0.055 Rs. 170.00
6. Ruta 30M (1 Bott. Pills) 0.055 Rs. 180.00

For commercial items only if known, Total Weight Total

HS tariff number (4) and country of origin of goods (5) (in kg) Value (7)
India 0.330 Rs. 1100.00
CUSTOMS May be Opened
Officially
DECLARATION
INDIA POST IMPORTANT: See instructions
on the back
Gift Commercial Sample

Documents  Other Tick one or more boxes

Quantity and detailed description Weight (in kg) Value (3)

Of Contents(1)
1. Aleos Socotrina 6M (1 Bott. Pills) 0.055 Rs. 400.00
2. Bryonia 30M (1 Bott. Pills) 0.055 Rs. 400.00
3. Colocynth 30M (1 Bott. Pills) 0.055 Rs. 400.00
4. Dulca Mara 6M (1 Bott. Pills) 0.055 Rs. 400.00
5. Erigeron 6M (1 Bott. Pills) 0.055 Rs. 500.00
6. Ciplar LA40 (180 Pills) 0.055 Rs. 638.00
7. Brass & Thread Cross for Prayers 1 No. 0.025 Rs. 512.00

For commercial items only if known, Total Weight Total

HS tariff number (4) and country of origin of goods (5) (in kg) Value (7)
India 0.355 Rs. 3250.00