Příloha II
EUROPEAN COMMUNITY SURVEILLANCE DOCUMENT
+-----+----------------------------------------+---------------------------------------------------------------------+
| 1 | 1. Consignee (name, full address, | 2. Issue number |
+-----+ country, VAT number) | |
| | | |
| | | |
| | +---------------------------------------------------------------------+
| | | 3. Proposed place and date of import |
| | | |
| | | |
| | | |
| | +---------------------------------------------------------------------+
| | | 4. Authority responsible for issue |
| | | (name, address and telephone No) |
| | | |
| | | |
| | | |
| +----------------------------------------+---------------------------------------------------------------------+
| | 5. Declarant/representative as | 6. Country of origin |
| | applicable | (and geonomenclature code) |
| | (name and full address) | |
| | | | |
| | | | |
| | | | |
| | +---------------------------------------------+-----------------------+
| | | 7. Country of consignment |
| | | (and geonomenclature code) |
| | | | |
| | | | |
| | | | |
| | +---------------------------------------------+-----------------------+
| | | 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 authorityÝs endorsement |
| | |
| | Date: |
| | |
| | |
| | Signature: Stamp: |
| | |
| | |
+-----+--------------------------------------------------------------------------------------------------------------+
+--------------------------------------------------------------------------------------------------------------------+
| 15. ATTRIBUTIONS |
| Indicate the quantity available in part 1 of column 17 and the quantity attributed in part 2 thereof. |
+------------------------------------------------+----------------------------+--------------------------------------+
| 16. Net quantity (net mass or other unit of | 19. Customs document | 20. Name, Member State, stamp |
| measure stating the unit) | (form and number) or | and signature of the attributing |
+----------------+-------------------------------+ extract No and date of | authority |
| 17. In figures | 18. In words for the quantity | attribution | |
| | attributed | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
Extensions pages to be attached hereto.
EUROPEAN COMMUNITY SURVEILLANCE DOCUMENT
+-----+----------------------------------------+---------------------------------------------------------------------+
| 2 | 1. Consignee (name, full address, | 2. Issue number |
+-----+ country, VAT number) | |
| | | |
| C | | |
| o | +---------------------------------------------------------------------+
| p | | 3. Proposed place and date of import |
| y | | |
| | | |
| f | | |
| o | +---------------------------------------------------------------------+
| r | | 4. Authority responsible for issue |
| | | (name, address and telephone No) |
| i | | |
| s | | |
| s | | |
| s +----------------------------------------+---------------------------------------------------------------------+
| u | 5. Declarant/representative as | 6. Country of origin |
| i | applicable | (and geonomenclature code) |
| n | (name and full address) | | |
| g | | | |
| | | | |
| a | | | |
| u | +---------------------------------------------+-----------------------+
| t | | 7. Country of consignment |
| h | | (and geonomenclature code) |
| o | | | |
| r | | | |
| i | | | |
| t | | | |
| y | +---------------------------------------------+-----------------------+
| | | 8. Last day of validity |
| | | |
+-----+ | |
| 2 | | |
+-----+----------------------------------------+---------------------------------------------------------------------+
| | 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 authorityÝs endorsement |
| | |
| | Date: |
| | |
| | |
| | Signature: Stamp: |
| | |
| | |
+-----+--------------------------------------------------------------------------------------------------------------+
+--------------------------------------------------------------------------------------------------------------------+
| 15. ATTRIBUTIONS |
| Indicate the quantity available in part 1 of column 17 and the quantity attributed in part 2 thereof. |
+------------------------------------------------+----------------------------+--------------------------------------+
| 16. Net quantity (net mass or other unit of | 19. Customs document | 20. Name, Member State, stamp |
| measure stating the unit) | (form and number) or | and signature of the attributing |
+----------------+-------------------------------+ extract No and date of | authority |
| 17. In figures | 18. In words for the quantity | attribution | |
| | attributed | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
| 1 | | | |
| | | | |
| | | | |
+----------------+ | | |
| 2 | | | |
| | | | |
| | | | |
+----------------+-------------------------------+----------------------------+--------------------------------------+
Extensions pages to be attached hereto.
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