Příloha II
EUROPEAN COMMUNITY SURVEILLANCE DOCUMENT
+-----+------------------------------------------------+----------------------------------------------------------+
| | 1. Consignee | 2. Issue number |
| 1 | (name, full address, country, VAT number) | |
+-----+ | |
| | +----------------------------------------------------------+
| | | 3. Proposed place and date of import |
| | | |
| | | |
| | +----------------------------------------------------------+
| | | 4. Authority responsible for issue |
| | | (name, address and telephone No) |
| H | | |
| O | | |
| L | | |
| D +------------------------------------------------+----------------------------------------------------------+
| E | 5. Declarant / representative as applicable | 6. Country of origin |
| R' | (name and full address) | (and geonomeclature code) |
| S | | | |
| | | | |
| C | +---------------------------------------------+------------+
| O | | 7. Country of consignment |
| P | | (and geonomenclature code) |
| Y | | | |
| | | | |
| | +---------------------------------------------+------------+
| | | 8. Last day of validity |
+-----+ | |
| | | |
| 1 | | |
+-----+------------------------------------------------+-----------+----------------------------------------------+
| 9. Description of goods | 10. CN code and category |
| | |
| | |
| +----------------------------------------------+
| | 11. Quantity in kilograms (net mass) or in |
| | additional units |
| | |
| | |
| +----------------------------------------------+
| | 12. Value in ecus, cif at Community frontier |
| | |
| | |
| | |
+------------------------------------------------------------+----------------------------------------------+
| 13. Additional remarks |
| |
| |
| |
| |
| |
| |
| |
+-----------------------------------------------------------------------------------------------------------+
| 14. Competent authority's endorsement |
| |
| Date:................................... |
| |
| Signature:.............................. Stamp |
| |
| |
+-----------------------------------------------------------------------------------------------------------+
+----------------------------------------------------------------------------------------------------------------------------------------------+
| 15. ATTRIBUTIONS |
| Indicate the quantity availabe in part 1 of column 17 and the quantity attributed in part 2 thereof |
+----------------------------------------------------------------------+------------------------+----------------------------------------------+
| 16. Net quantity (net mass or other unit of measure stating the unit | 19. Customs document | 20. Name, Member State, stamp and signature |
| | (from and number) | of the attributing authority |
| | or extract No and | |
| | date of attribution | |
+-----------------+----------------------------------------------------+ | |
| 17. In figures | 18. In words for the quantity attributed | | |
| | | | |
+-----------------+----------------------------------------------------+------------------------+----------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
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+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
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+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
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+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
Extension pages to be attached hereto.
EUROPEAN COMMUNITY SURVEILLANCE DOCUMENT
+----+----------------------------------------------+-----------------------------------------------------
| | 1. Consignee | 2. Issue number
| 2. | (name, full address, country, VAT number) |
| | |
+----+ |
| | |
| | +-----------------------------------------------------
| C | | 3. Proposed place and date of import
| O | |
| P | |
| Y | |
| | |
| F | +-----------------------------------------------------
| O | | 4. Authority responsible for issue
| R | | (name, address and telephone No)
| | |
| T | |
| H | |
| E | |
| | |
| I +----------------------------------------------+-----------------------------------------------------
| S | | 6. Country of origin
| S | 5. Declarant / representative as applicable | (and geonomenclature code)
| U | (name and full address) |
| I | |
| N | |
| G | | |
| | +------------------------------------------+----------
| A | | 7. Country of consignment
| U | | ( and geonomenclature code)
| T | |
| H | |
| O | |
| R | | |
| I | +------------------------------------------+----------
| T | | 8. Last day of validity
| Y | |
| | |
| | |
+----+ |
| 2. | |
| | |
+----+----------------------------------------------+--------------+--------------------------------------
| 9. Desction of goods | 10. CN code and category
| |
| |
| +--------------------------------------
| | 11. Quantity in kilograms (net mass)
| | or in additional units
| |
| |
| +--------------------------------------
| | 12. Value in ecus, cif at Community
| | frontier
| |
| |
+-------------------------------------------------------------+--------------------------------------
| 13. Additional remarks
|
|
|
|
|
|
|
+----------------------------------------------------------------------------------------------------
| 14. Competent authority's endorsement
|
| Date:................................
|
| Signature:........................... Stamp
|
|
+----------------------------------------------------------------------------------------------------
+----------------------------------------------------------------------------------------------------------------------------------------------+
| 15. ATTRIBUTIONS |
| Indicate the quantity availabe in part 1 of column 17 and the quantity attributed in part 2 thereof |
+----------------------------------------------------------------------+------------------------+----------------------------------------------+
| 16. Net quantity (net mass or other unit of measure stating the unit | 19. Customs document | 20. Name, Member State, stamp and signature |
| | (from and number) | of the attributing authority |
| | or extract No and | |
| | date of attribution | |
+-----------------+----------------------------------------------------+ | |
| 17. In figures | 18. In words for the quantity attributed | | |
| | | | |
+-----------------+----------------------------------------------------+------------------------+----------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 1. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
| 2. | |
| | |
+-----------------+----------------------------------------------------------------------------------------------------------------------------+
Extension pages to be attached hereto.
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