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Collect Other Charges Shipper certifies that the particulars on the face hereof are correct and that insofar as any part of the consignment contains dangerous goods, such part is property described by name and is in proper condition for carriage by air according to the applicable Dangerous Goods Regulations. Signature of Shipper or his Agent Total Collect CC Charges in Dest. Currency Executed on (date) Charges at Destination Total Collect Charges at (place) Signature of issuing Carrier or its Agent
Prepaid
Weight Charge
Valuation Charge
Tax
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289
Total Other Charges Due Agent
Total Other Charges Due Сarrier
Total Prepaid
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Currency Conversion Rates
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