Customs Clearance Payment Receipt
Customs Clearance Payment Receipt
NUMBER (WAYBILL/ORDER)/ID:
NUMBER / TYPE OF CONTAINER:
KEY / COMPL. IDENTIFIER
REMARKS
CUSTOMS BROKER, CUSTOMS BROKER OR WAREHOUSE AGENT I DECLARE UNDER OATH, IN ACCORDANCE WITH
NAME OR REZ. SOC: THE PROVISIONS OF ARTICLE 81 OF THE CUSTOMS
LAW: PATENT OR AUTHORIZATION:
AUTOGRAPHED SIGNATURE
ANNEX TO THE REQUEST Page2 of 2
NUM. PEDIMENTO: TYPE OF OPER. CVE. PEDIM: RFC:
CURP:
ITEMS
FRACTION SUBD. VINC. ME UMC CANT UMT AMOUNT P. P.
T UMC UMT V/C O/D
VAL
SEC DESCRIPTION (VARIABLE LINES AS REQUIRED) CON. RATE T.T. F.P. AMOUNT
002
003
CUSTOMS BROKER, CUSTOMS BROKER OR WAREHOUSE I DECLARE UNDER OATH, IN ACCORDANCE WITH THE PROVISIONS
AGENT OF ARTICLE 81 OF THE CUSTOMS LAW: PATENT OR
NAME OR REZ. SOC: AUTHORIZATION:
RFC: CURP:
AUTOGRAPHED SIGNATURE