98-00 中華郵政公司 CHUNGHWA POST CO., LTD. 國際(地區)包裹五聯單 (寄件人名地址 Name & address of sender 合約編號, Contract No. ICC921 8 9 6 1 8 5 T W CC921896185TW Postal Code TAIWAN [航空 √ 水陸口 TO 姓名及地址 Name and address of addressee AIR MAIL SURFACE 保價 保價金額 尖山路 數字 Figures 特別提款權 Insurance Insured value - Words 新臺幣(元) NTS SDR Insured value SDR |之注寄 次意 日: 起本人 國名(地區 數量 內裝物品 List of contents The item/parcel may be opened officially Number of items Country (Area) of origin of goods Value 3000- 本件可依規定拆驗 主價值: NT$ |實際重量 尺寸(公分) Gross Weight Gift Documents Commercial Sample Returned Sales of Goods Goods Others Please specify 其他請詳述 銷售物品 退貨: 禮品 文件 商業貨樣: 若無法投遞時,寄件人之指定事項 Sender's instructions in case of non-delivery 凡勾:「批棄」以外者,同意支付退回(改寄費 (Agree to pay return or redirection charges concerned) (僅適用於受理改寄之國家 (地區)) 以實際可用郵路退回寄件人: 稅則號數(請已知) (Tariff No (if known) Redirect to address below: 要證明本人於本報關單所列資料正確且郵件無郵政規則票寄之化 險物品,如有不實,願負全部責任。 本人同意無法投遞時應支付之各項費用。 I certify that the particulars given in the customs declaration are correct Postage and that this item does not contain any dangerous article prohibited by postal regulations. False information is punishable by law. I also agree to pay the costs relato adja of non-delivery. 寄件人簽署及日期。 Date and sender's signature 4 A 自備郵資 拋棄 Office of origin Treat as abandoned 原寄郵局 Only available for the post accepted alteration of address Return to sender by available routes 虎尾 | Date mailed 交寄日期(西曆/ 營業郵資券」 610 Dimensions in CM Length Width 材積重量(公斤) Vol. wt 公斤 Kg 將情 (Kg) 長x寬x高(公分)/6000=材積重公) 日 Date Stamp 經辦員簽署 交日 驗後 。如 商Height Drawn by 4.25 JENTS ENTS 寄件人聯 Sender's Copy 注意:本執據由寄件人妥慎保管,日後如需查詢請於交寄 執管 此篇相同回報者之文章列表

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