| 1．申領許可證單位 編碼Exporter | 3．出口許可證編號License No. | ||||
| 2．發貨單位Consignee | 4．許可證有效期Validity | ||||
| 5．貿易方式Terms of trade | 8．輸往國家（地區）Country of destination | ||||
| 6．合同號Contract No. | 9．收款方式Terms of payment | ||||
| 7．出運口岸Port of shipment | 10．運輸方式Means of transport | ||||
| 11．嘜頭---包裝件數Marks & numbers---number of packages | |||||
| 12．商品名稱 商品編碼Description of commodity Commodity No. | |||||
| 13．商品規格、型號Specification | 單位Unit | 14．單位Quantity | 15．單價Unit price | 16．總值Amount | 17．總值折美元Amount in USD |
| 18．總計Total | |||||
| 19．備註Supplementary | 20．發證機關蓋章Issuing Authority’s Stamp發證日期Signature Date | ||||
