| | | А.Т.А. CARNET | | | | | | | | | | | | | | CARNET A.T.A. | |
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R E E X P O R T A T I O N
| R E 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. | REEXPORTATION VOUCHER No | | |
| | | | Volet de reexportation 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 RE-EXPORTATION / | |
| | | | | | Dedouanement a la reexportation | |
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| | | | | a) | The goods referred to in paragraph F. a) and b) of | |
| | | | | | the holder's declaration have been re-exported. / Les | |
| | | | | | marchandises visees au paragraphe F. a) et b) de la | |
| | | | | | declaration ci-contre ont ete reexportees. | |
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| | | E. | PACKAGING DETAILS (Number, Kind, Marks, etc.) <*> / | b) | Action taken in respect of goods produced but not | |
| | | | Detail d'emballage (nombre, nature, marques, etc.) <*> | | re-exported <*>. / Mesures prises a l'egard des | |
| | | | | | marchandises representees mais non reexportees <*>. | |
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| | | F. | RE-EXPORTATION DECLARATION / | c) | Action taken in respect of goods NOT produced and | |
| | | | Declaration de reexportation | | NOT intended for later re-exporation <*>. / Mesures | |
| | | | | | prises a l'egard des marchandises non representees et | |
| | | | | | non destinees a une re-exportation ulterieure <*>. | |
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| | | | I, duly authorised: / Je soussigne, dument autorise: | d) | Registered under reference No.: <*> / Enregistre sous le | |
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| | | | <*> a) | declare that I am re-exporting the goods | | e) | This voucher must be forwarded to the Customs | |
| | | | | enumerated in the list overleaf and | | | Office at <*>: / Le present volet devra etre transmis au | |
| | | | | described in the General List under item | | | bureau de douane de: | | |
| | | | | No.(s) / declare reexporter les marchandises | | | | | | | | | | | | |
| | | | | enumerees a la liste figurant au verso et | | | | | | | | | | | | |
| | | | | reprises a la liste generale sous le(s) N(s) | | | | | | | | | | | | |
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| | | | | which were temporarily imported under | | | | | | | | | | | | |
| | | | | cover of importation voucher(s) N(s) / qui ont | | | | | | | | | | | | |
| | | | | ete importees temporairement sous le couvert | | | | | | | | | | | | |
| | | | | du (des) volet(s) d'importation N(s) | | | | | | | | | | | | |
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| | | | | of this carnet / du present carnet | | f) | Other remarks: <*>; / Autres mentions: <*>; | |
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| | | | <*> b) | declare that goods produced against the | | | | | | | | | | | | |
| | | | | following item N(s) are not intended for | | | | | | | | | | | | |
| | | | | re-exportation: / declare que les marchandises | | | | | | | | | | | |
| | | | | representees et reprises sous le(s) N(s) | | | At / A | | |
| | | | | suivant(s) ne sont pas destinees a la | | | | Customs Office / Bureau de douane | |
| | | | | reexportation: | | | | | | | | | | | | |
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| | | | <*> c) | declare that goods of the following item N(s) | | | | | | | | | | |
| | | | | not produced, are not intended for later | | | | | | | | | | | | |
| | | | | re-exportation: / declare que les marchandises | | | / | / | | | | | |
| | | | | non representees et reprises sous le(s) N(s) | | | Date (year / month / day) | | Signature and Stamp | | |
| | | | | suivant(s) ne seront pas reexportees | | | Date (annee / mois / jour) | | Signature et Timbre | | |
| | | | | ulterieurement: | | | | | | | | | | | | |
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| | | | <*> d) | in support of this declaration, present the | | | | | | | | | | | | |
| | | | | following documents: / presente a l'appui de | | | Place | | | Date (year / month / day) | / | / | | |
| | | | | mes declarations, les documents suivants: | | | Lieu | | | Date (annee / mois / jour) | | | | |
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| | | | e) | confirm that the information given is true | | | | | | | | | | | | |
| | | | | and complete. / certifie sinceres et completes les | | | Name | | |
| | | | | indications portees sur le present volet. | | | Nom | | |
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| | | | | | | | | | | | | | | | Signature | | Signature | | |
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