PEDIMENTO

NUM. PEDIMENTO:

T. OPER

DESTINO:

TIPO CAMBIO:

REGIMEN:

PESO BRUTO:

MEDIOS DE TRANSPORTE
ENTRADA/SALIDA:

Pgina 1 de N

CVE. PEDIMENTO:

CERTIFICACIONES

ADUANA E/S:

VALOR DOLARES:

ARRIBO:

SALIDA:

VALOR ADUANA:
PRECIO PAGADO/VALOR
COMERCIAL:

DATOS DEL IMPORTADOR /EXPORTADOR

RFC:

NOMBRE, DENOMINACION O RAZON SOCIAL:

CURP:
DOMICILIO:
VAL.SEGUROS

SEGUROS

FLETES

EMBALAJES

ACUSE
DE VALIDACION:

OTROS INCREMENTABLES

ELECTRONICO CLAVE DE LA SECCION

ADUANERA DE
DESPACHO:

MARCAS, NUMEROS Y TOTAL DE BULTOS:

FECHAS

TASAS A NIVEL PEDIMENTO

CONTRIB.

CVE. T. TASA

TASA

CUADRO DE LIQUIDACION
CONCEPTO

F.P.

IMPORTE

CONCEPTO

F.P.

IMPORTE

TOTALES
EFECTIVO
OTROS
TOTAL

DATOS DEL PROVEEDOR O COMPRADOR

ID. FISCAL

NOMBRE, DENOMINACION O RAZON SOCIAL

NUM. FACTURA

FECHA

INCOTERM

MONEDA FACT

TRANSPORTE

DOMICILIO:

VINCULACION

VAL.MON.FACT

FACTOR MON.FACT

IDENTIFICACION:

VAL.DOLARES

PAIS:

TRANSPORTISTA

RFC

CURP

DOMICILIO/CIUDAD/ESTADO

NUMERO (GUIA/ORDEN EMBARQUE)/ID:

NUMERO / TIPO DE CONTENEDOR:
DESCARGOS
NUM. PEDIMENTO ORIGINAL:

FECHA DE OPERACION ORIGINAL:

CVE. PEDIMENTO ORIGINAL:

OBSERVACIONES

PARTIDAS
FRACCION
SEC

SUBD.

VINC.

MET VAL

UMC

CANTIDAD UMC

UMT

CANTIDAD UMT

P. V/C

P. O/D

DESCRIPCION (RENGLONES VARIABLES SEGUN SE REQUIERA)

VAL ADU/USD

IMP. PRECIO PAG.

PRECIO UNIT.

MARCA

CON.

VAL. AGREG.
MODELO

CODIGO PRODUCTO

REGULACIONES, RESTRICCIONES NO ARANCELARIAS Y NOM

CLAVE

IDENTIF.

NUM. PERMISO O FIRMA

NOM
DESCARGO
COMPLEMENTO 1

VAL.
DLS.

COMPLEMENTO 2

COM. CANTIDAD
UMT/C
COMPLEMENTO 3

TASA

T.T.

F.P.

IMPORTE

CUSTOMS DECLARATION
DECLARATION NO.:

TYPE OF OPERATION:

DESTINATION:

EXCHANGE RATE:

GROSS WEIGHT:

MEANS OF TRANSPORT
ENTRY / EXIT:

Page 1 of N

DECLARATION CODE:

SYSTEM:

CERTIFICATIONS

CUSTOMS E/E:

VALUE IN DOLLARS:

ARRIVAL:

EXIT:

CUSTOMS VALUE:
PRICE PAID / COMMERCIAL VALUE:

INFORMATION ON IMPORTER / EXPORTER

RFC:

NAME OR COMPANY NAME:

CURP:
ADDRESS:
INSURANCE
VALUE

FREIGHT

INSURANCE

PACKAGING

ELECTRONIC ACKNOWLEDGEMENT OF VALIDATION:

ADDITIONAL

CODE FOR CUSTOMS

SECTION:

TRADE NAMES, NUMBERS AND TOTAL NO. OF PACKAGES:

DATES

CUSTOMS DECLARATION RATES

CONTRIB.

RATE

CODE FOR TYPE

OF RATE

LIQUIDATION TABLE
ITEM

F.P.

COST

ITEM

F.P.

COST

TOTALS
CASH
OTHERS
TOTAL

INFORMATION ON SUPPLIER / PURCHASER

FISCAL ID

NAME OR COMPANY NAME

INVOICE NO.

DATE

INCOTERM

ADDRESS:

INVOICE
CURRENCY

TRANSPORT

LINK

INVOICE
VALUE

INVOICE CURRENCY
FACTOR

IDENTIFICATION:

VALUE IN
DOLLARS

COUNTRY:

CARRIER

RFC

CURP

ADDRESS / CITY / STATE

(LOADING ORDER/TRACKING) / ID NUMBER:

NUMBER / TYPE OF CONTAINER:
DISCHARGES
NO. OF ORIGINAL DECLARATION:

DATE OF ORIGINAL OPERATION:

CODE OF ORIGINAL DECLARATION:

OBSERVATIONS

ITEMS
CODE
SEC

SUBD.

LINK

MET VAL

CUM

CUM AMOUNT

TUM

TUM AMOUNT

C. S/P

C. O/D

DESCRIPTION (USE AS MANY LINES AS NECESSARY)

CUS/USD VALUE TOTAL PRICE PAID
TRADE NAME

ITEM

UNIT PRICE

AGGREGATE
VALUE
MODEL

PRODUCT CODE

NON-TARIFF REGULATIONS AND RESTRICTIONS, AND NOMs

CODE
IDENTIF.

LICENSE NO. OR DISCHARGE

NOM
SIGNATURE
COMPLEMENT 1

COM.
VAL.
DOLLARS

COMPLEMENT 2

CUM/TUM
AMOUNT

COMPLEMENT 3

RATE

T.R.

F.P.

COST

DCLARATION
No DCLARATION :
DESTINATION :

T. OPER
TAUX DE CHANGE :

POIDS BRUTE :

MOYENS DE TRANSPORT
ENTRE/SORTIE :

Page 1 de N

CODE DE DCLARATION : RGIME :

CERTIFICACIONS

DOUANE E/S :

VALEUR EN DOLLARS :

ARRIVE :

SORTIE :

VALEUR DOUANIRE :
PRIX PAY /
VALEUR COMMERCIALE :

DONNES RELATIVES LIMPORTATEUR / LEXPORTATEUR

RFC :

NOM, DNOMINATION OU RAISON SOCIALE

CURP :
DOMICILE :
VALEUR
DES ASSURANCES
ASSURANCES

FRETS

EMBALLAGES

ACCUS LECTRONIQUE DE VALIDATION :

AUTRES
INCREMENTABLES
CODE DE LA SECTION
DOUANIRE DE
DDOUANEMENT :

MARQUES, NUMROS ET TOTAL DES COLIS :

DATES

TAXE APPLICABLE LA DCLARATION

CONTRIBUTION

CODE TARIFAIRE

TAXE

CADRE DE LIQUIDATION
CONCEPT

F.P.

MONTANT

CONCEPT

F.P.

MONTANT

TOTAUX
COMPTANT
AUTRES
TOTAL

DONNES RELATIVES AU FOURNISSEUR OU LACHETEUR

ID. FISCAL

NOM, DNOMINATION OU RAISON SOCIALE

No DE
FACTURE

DATE

INCOTERM

DOMICILE :

DEVISE
ORIGINALE DE
LA FACTURE

TRANSPORT

FIXATION DES
COURS
VALEUR EN
DOLLARS

FACTEUR DE
CONVERSION DU
MONTANT DE LA
FACTURE

MONTANT DE
LA FACTURE
EN DEVISE
ORIGINALE

IDENTIFICATION :

PAYS :

TRANSPORTEUR

RFC

CURP

DOMICILE/VILLE/TAT

NUMRO (GUIDE / BORD. DEXPDITION)/ID:

NUMRO / TYPE DE CONTENEUR :
DCHARGEMENTS
No DCLARATION ORIGINAL:

DATE DE LOPRATION ORIGINALE :

CODE DE DCLARATION ORIGINAL :

OBSERVATIONS

PARTIES
NUMRO

SUBD.

VINC.

MET VAL

UMC

QUANTIT UMC

UMT

QUANTIT UMT

P. V/C

P. O/D

SEC DESCRIPTION (LIGNES VARIABLES EN FONCTION DES BESOINS)

VAL.
DOUANIRE
/USD

TAXE SUR LE PRIX PRIX UNIT.

PAY.
MARQUE

CON.

VAL. TOTALE

MODLE

CODE DE PRODUIT

RGLEMENTS, RESTRICTIONS NON TARIFAIRES ET NOM

CODE

No DE PERMIS OU SIGNATURE
DE NOM
DCHARGE DE
RESPONSABILIT

VALEUR
COM EN $

QUANTIT UMT/C

TASA

T.T.

F.P.

MONTANT

IDENTIF.

COMPLMENT 1

COMPLMENT 2

COMPLMENT 3