| | | А.Т.А. CARNET | | | | | | | | | | | | | | CARNET A.T.A. | |
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E X P O R T A T I O N
| E X P O R T A T I O N
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| A. | HOLDER AND ADDRESS / Titulaire et adresse | | FOR ISSUING ASSOCIATION USE / | |
| | | | Reserve a l'association emettrice | |
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| | | G. | EXPORTATION VOUCHER N | | |
| | | | Volet d'exportation n | | | | | |
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| | | a) | CARNET No. | | | | | |
| | | | | | | | | | | | | Carnet N | | | | | |
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| B. | REpreSENTED BY <*> / Represente par <*> | b) | ISSUED BY / Delivre par | | | | | |
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| C. | INTENDED USE OF GOODS / Utilisation prevue des | c) | VALID UNTIL / Valable jusqu'au | | | | | |
| | marchandises | | | | | | | | | | | | |
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| | | | year | | month | | day (inclusive) | | | | | |
| | | | annee | | mois | | jour (inclus) | | | | | |
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| | | D. | MEANS OF trANSPORT <*> / Moyens de transport <*> | | FOR CUSTOMS USE ONLY / Reserve a la douane | |
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| | | | | H. | CLEARANCE ON EXPORTATION / | |
| | | | | | Dedouanement a l'exportation | |
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| | | | | a) | The goods referred to in the above declaration have been exported / | |
| | | | | | Les marchandises faisant t'objet de la declaration ci-contre ont ete exportees. | |
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| | | E. | PACKAGING DETAILS (Number, Kind, Marks, etc.) <*> / | b) | Final date for duty-free reimportation / | |
| | | | Detail d'emballage (nombre, nature, marques, etc.) <*> | | Date limite pour la reimportation en franchise: | |
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| | | | | | year | | month | | day (inclusive) | | | | | |
| | | | | | annee | | mois | | jour (inclus) | | | | | |
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| | | F. | TEMPORARY EXPORTATION DECLARATION / | c) | This voucher must be forwarded to the Customs Office at: <*>; / | |
| | | | Declaration d'exportation temporaire | | Le present volet devra etre transmis au bureau de douane de: <*>; | |
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| | | | | d) | Other remarks: <*>; / Autres mentions: <*>; | | | |
| | | | I, duly authorised: / Je soussigne, dument autorise: | | | | | | | | | | | | |
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| | | | a) | declare that I am temporarily exporting the | | | | | | | | | | | | |
| | | | | goods enumerated in the list overleaf and | | | | | | | | | | | | |
| | | | | described in the General List under item No.(s) / | | | | | | | | | | | | |
| | | | | declare exporter temporairement les | | | At / A | | |
| | | | | marchandises enumerees a la liste figurant au | | | | Customs Office / Bureau de douane | |
| | | | | verso et reprises a la liste generale des | | | | | | | | | | | | |
| | | | | marchandises sous le(s) N(s). | | | | | | | | | | | | |
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| | | | b) | undertake to re-import the goods within the | | | | | | | | | | | | |
| | | | | period stipulated by the Customs Office or | | | | | | | | | | | |
| | | | | regularize their status in accordance with the | | | | | | | | | | |
| | | | | laws and regulations of the country / | | | | | | | | | | |
| | | | | Customs territory of importation / | | | | | | | | | | | |
| | | | | m'engage a reimporter ces marchandises | | | / | / | | | | | |
| | | | | dans le delai fixe par le bureau de douane ou | | | Date (year / month / day) | | Signature and Stamp | | |
| | | | | a regulariser leur situation selon les lois et | | | Date (annee / mois / jour) | | Signature et Timbre | | |
| | | | | reglements du pays / | | | | | | | | | | | | |
| | | | | territoire douanier d'importation. | | | | | | | | | | | | |
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| | | | c) | confirm that the information given is true | | | Place | | | Date (year / month / day) | / | / | | |
| | | | | and complete / certifie sinceres et completes les | | | Lieu | | | Date (annee / mois / jour) | | | | |
| | | | | indications portees sur le present volet. | | | | | | | | | | | | |
| | | | | | | | Name | | |
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| | | | | | | | | | | | | | | | Signature | | Signature | | |
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