Pro forma invoice.

§ 141.85 Pro forma invoice. A pro forma invoice submitted in accordance with any provision of this chapter shall be in substantially the following form: Pro Forma Invoice Importers Statement Of Value Or The Price Paid In The Form Of An Invoice Not being in possession of a commercial seller's or shipper's invoice I request that you accept the statement of value or the price paid in the form of an invoice submitted below: Name of shipper address ____________ Name of seller address ____________;. Name of consignee address ____________. Name of purchaser address ____________. The merchandise (has) (has not) been purchased or agreed to be purchased by me. The prices, or in the case of consigned goods the values, given below are true and correct to the best of my knowledge and belief, and are based upon: (Check basis with an “X”) (a) The price paid or agreed to be paid (_) as per order dated ______. (b) Advices from exporter by letter (—) by cable (_) dated ______. (c) Comparative values of shipments previously received (_) dated ______. (d) Knowledge of the market in the country of exportation (_) ______. (e) Knowledge of the market in the United States (if U.S. Value) (_) ______. (f) Advice by CBP (_) ______. (g) Other (_) ______. A—Case marks numbers B—Manufacturer's item No. symbol or brand C—Quantities and full description D—Unit purchase price (currency) E—Total purchase price (currency) F—Unit foreign value G—Total foreign value Check which of the charges below are, and which are not included in the prices listed in columns “D” and “E”: Amount Included Not included Packing Cartage Inlandfreight Wharfage and loading abroad Lighterage Ocean freight U.S. duties Other charges (identify by name and amount)    Total Country of origin ____________. If any other invoice is received, I will immediately file it with an authorized CBP official.   (Signature of person making invoice)    (Title and firm name) Date [T.D. 73-175, 38 FR 17447, July 2, 1973, as amended by T.D. 85-39, 50 FR 9612, Mar. 11, 1985]