DEPARTMENT OF THE TREASURY

UNITED STATES CUSTOMS SERVICE

19 U.S.C. 141, 1482, 1484

SPECIAL CUSTOMS INVOICE

(Use separate invoice for purchased and non-purchased goods.)

Form Approved.

O.M.B.No. 48-RO 342

1. SELLER

2. DOCUMENTS NR.*

3. INVOCIE NR. AND DATE*

4. REFERENCES*

5. CONSIGNEE

6. BUYER (if other than consignee)

7. ORIGIN OF GOODS

8. NOTIFY PARTY*

9. TERMS OF SALE, PAYMENT, AND DISCOUNT

10. ADDITIONAL TRANSPORTATION INFORMATION*

11. CURRENCY USED

12. EXCH RATE (if fixed or ogreed)

13. DATE ORDER ACCEPTED

IN USD

14.

MARKS AND NUMBERS ON

SHIPPING PACKAGES

15.

NUMBER OF

PACKAGES

16.

FULL DESCRIPTION

OF GOODS

17.

QUANTITY

UNIT PRICE

20.

INVOICE TOTALS

18.HOME

MARKET

19.INVOICE

21.

□

If the production of these goods involved furnishing goods or services to the seller (e.g., assists such as dies, molds,

Tools, engineering work) and the value is not included in the invoice price, check box (21) and explain below.

22. PACKING COSTS

27. DECLARATION OF SELLER/SHIPPER (OR AGENT)

23. OCEAN OR

INTERNATIONAL

FREIGHT

I declare:

(A)

□

If the are any rebates, drawbacks or

bounties allowed upon the exportation

of goods, I have checked box (A) and

itemized separately below.

(B)

□

If the goods were not sold or agreed to be sold, I have checked

box (B) and have indicated in column 19 the price I would be

willing to receive.

24. DOMESTIC

FREIGHT CHARGES

25. INSURANCE

COSTS

I further declare that there is no other invoice

differing from this one (unless otherwise described

below) and that all statements contained in this

invoice and declaration are true and correct.

26. OTHER COSTS

(Specify Below)

28. THIS SPACE FOR CONTINUING ANSWERS

THIS FORM OF INVOICE REQUIRED GENERALLY IF RATE OF DUTY BASED UPON OR REGULATED BY VALUE OF GOODS AND PURCHASE PRICE OR VALUE OF SHIPMENT EXCEEDS $500. OTHERWISE USE COMMERICAL INVOICE.

*Not necessary for U.S.Customs purposes.

Printed by CHEUNG LEE PRINTING CO., 204 Li Po Chun Chambers 185 Des Voeux Road. C., Hong Kong Tel: 5-438069. 5-441501

Customs Form 5515 (12-20-76)

　　海关发票(CUSTOMS INVOICE)是一种特殊用途的发票，由出口商填制。往往在一些关税优惠、倾销、反倾销等类似情况出现，供进口国海关审查货物的原产地、货物实际价格及统计定税之需。海关发票有不同种类，不同国家使用不同的格式，但内容大同小异。

　　美国海关发票(SPECIAL CUSTOMS INVOICE)包括FORM5515(服装)，Textile Export License/Commercial Invocie(棉纺织品)，FORM5520 "Special Summary Stell Invoice"(钢铁)，FORM5523(鞋类)。

　　注：第2、3、4、8、10栏指并非美国海关意图的项目，可不填。

　　如最终买方不是收货人，则填最终买方名址，否则填“Same As Consignee”。

　　填原产国名，如货物含有非原产国材料，本栏填写“N/A”即（Not Applicable）。

　　此处需填两个内容：价格术语和支付方式。当有佣金、折扣时，可于此表示。例：CIF C3%，sight L/C。

　　需填运输单据号码，运输方式，启运地（港），目的地（港）；如有转运，填转运地（港）。

　　填写不同规格的商品的最大包装件数与包装方式。若有两种或两种以上不同规格商品，此栏目最下方将总件数累加，并用“……”相隔。

　　填用以计价的计量单位之数目，不同规格不同商品分计后累加。

　　填写时，先分别填写相同规格的单价与数量的乘积，然后填写全部乘积之和。15～20栏内容一一对应。

21.If the production of these goods involved furnishing goods or services to the seller (e.g., assists such as dies, molds, Tools, engineering work) and the value is not included in the invoice price, check box (21) and explain below.

　　如果货物生产包括向卖方提供的货物或服务（如冲压、制模具、工程作业），且没计入发票价格的，请在21栏划“√”，并解释如下：

　　A. If the are any rebates, drawbacks or bounties allowed upon the exportation of goods, I have checked box (A) and itemized separately below. 如果出口货物有任何折扣、退税或补贴，我方已在方格A中填入“√”，并分别列在下方（指28栏）。

　　B. If the goods were not sold or agreed to be sold, I have checked box (B) and have indicated in column 19 the price I would be willing to receive. 如果货物非为销售或同意销售的，我方已在B格内填入“√”，并在19栏注明愿意接受的价格。

　　C. I further declare that there is no other invoice differing from this one (unless otherwise described below) and that all statements contained in this invoice and declaration are true and correct. 我方声明除非发票内有其他说明，否则无与此不同的其他发票，而且此发票内的一切声明和申请都是真实正确的。

　　SIGNATURE OF SELLER/SHIPPER (OR AGENT):　卖方／托运人或其代理签字，用手签。

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