A pro forma invoice submitted in accordance with any provision of this chapter shall be in substantially the following form:

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Terms Used In 19 CFR 141.85

  • CBP: means U. See 19 CFR 101.1
  • Country: means the political entity known as a nation. See 19 CFR 134.1
  • Exportation: means a severance of goods from the mass of things belonging to this country with the intention of uniting them to the mass of things belonging to some foreign country. See 19 CFR 101.1
  • United States: includes all territories and possessions of the United States, except the Virgin Islands, American Samoa, Wake Island, Midway Islands, Kingman Reef, Johnston Island, and the island of Guam. See 19 CFR 134.1

Pro Forma InvoiceImporters Statement Of Value Or The Price Paid In The Form Of An Invoice

Not being in possession of a commercial seller’s or shipper’s invoice I request that you accept the statement of value or the price paid in the form of an invoice submitted below:

Name of shipper address ________________________Name of seller address ________________________;. Name of consignee address ________________________.Name of purchaser address ________________________.

The merchandise (has) (has not) been purchased or agreed to be purchased by me.

The prices, or in the case of consigned goods the values, given below are true and correct to the best of my knowledge and belief, and are based upon: (Check basis with an “X”)

(a) The price paid or agreed to be paid (__) as per order dated ____________.

(b) Advices from exporter by letter (—) by cable (__) dated ____________.

(c) Comparative values of shipments previously received (__) dated ____________.

(d) Knowledge of the market in the country of exportation (__) ____________.

(e) Knowledge of the market in the United States (if U.S. Value) (__) ____________.

(f) Advice by CBP (__) ____________.

(g) Other (__) ____________.

A—Case marks numbersB—Manufacturer’s item No. symbol or brandC—Quantities and full descriptionD—Unit purchase price (currency)E—Total purchase price (currency)F—Unit foreign valueG—Total foreign value

Check which of the charges below are, and which are not included in the prices listed in columns “D” and “E”:

AmountIncludedNot included
Packing
Cartage
Inlandfreight
Wharfage and loading abroad
Lighterage
Ocean freight
U.S. duties
Other charges (identify by name and amount)
Total

Country of origin ________________________.

If any other invoice is received, I will immediately file it with an authorized CBP official.

(Signature of person making invoice) (Title and firm name)Date[T.D. 73-175, 38 FR 17447, July 2, 1973, as amended by T.D. 85-39, 50 FR 9612, Mar. 11, 1985]