CAS
[Paragraphs 8B.5(iii)]

Statement of export shipments made on 'charges collect' basis and repatriation of the funds involved for the month ended .......199
(To be submitted in duplicate)

Name of the freight forwarder:
_____________________________________________________
Address & Phone No.
__________________________________________________________
_
__________________________________________________________
_
Part 'A' Charges collect shipments sent
Sr. Details of export shipments
No.
Name of the
overseas agent
MAWB *
MBL No. & date/
HAWB *
HBL No. &
date
Destination Freight paid
to *shipping/
airline
company
Rs.,
Charges to be
collected by
agent abroad
U.S.$
(1) (2) (3) (4) (5) (6) (7)
(i) Shipments of earlier months for which payments were to be received at the beginning of the month
(1)
(2)
(3)
(4)
(ii) Shipments sent during the month
(1)
(2)
(3)
(4)
Part 'B': Repatriation of charges collected
Sr. Details of export shipments
No.
Name of the
overseas
agent MAWB *
MBL No. &
date/
HAWB *
HBL No. &
date
Destination
Charges
to be
collected
U.S.$
Charges
received
U.S.$
Date of
Receipt
BBA’s
fees
(6-7)
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Notes: (i) Copies of relevant MAWB/MBL & HAWB/HBL should accompany Part 'A'
________________________________
Place: (Signature of authorised official)
Stamp
Name:___________________________
Date: Designation:______________________
* Strike out whichever is not applicable.
Certificate from the Chartered Accountant
Certified that the particulars furnished above have been verified with reference to the books of
account and bank certificate verified for the inward remittance received for the purpose as per
column 7 above.
Place: Signature :
Date: Status :
Chartered Accountant
Registration No.________________________