1050 Lakes Drive,Suite 150,West Covina,CA91790,U.S.A.
Tel : (626 )919-8802 Fax: (626)919-8903
email:
Inspection Application Form
CCIC Reference No.: NASCVerification Order NO.
Applicant:Address:
Contact Person:
Tel.:
Fax:
EMAIL: / Commodity Description:
Quantity:
Description of Goods:
H.S. No.:
Detailed Address of Inspection Site:
Contact Person:
Tel:
Estimated inspection date:
Additional document required upon inspection:
1.Copy of B/L
2.Copy of Final Invoice
3.Packing list
4.Exporter’s Statement Letter
Consigner:
Address:
Consignee:
Address：
Description of Inspection：
Physical Inspection of Goods
a)Quantity/volume/weight of goods
b)Classification of Goods pursuant to Indonesian Customs HS book 2007 version reffered to as “BTBMI2007”
c)General condition of outer packing of goods
d)Container Condition
e)Supervision of stuffing of goods into the container
f)Sealing of containers by surveyor Partner
g)Taking photograph of the entire process of physical inspection and supervision of stuffing of goods based on the prevailing procedures i.e.
1. Empty Container photo with container number
2. 1/2 loaded with container number
3. Full loaded with container number (Door - opened)
4. Full loaded with container number (Door - half closed)
5. Closed Container
6. Seal number
Declaration: This company has carefully read and understood the following application and inspection terms. This company agrees to and accepts these terms. We apply to CCIC North America Inc. for a commercial inspection on the commodity above.
Legal Authorized Signature:
Print Name: Application Date:
***********************************************************************************************
Application and Inspection Terms:
1)Applicants should complete this Form by themselves in legible handwriting, preferably typed. No field or space should be left blank except CCIC Reference No. CCICNA will not accept any application with illegible handwriting, missing or incomplete information, or any application without authorized signature. Incorrect information will cause the commercial inspection to delay or to be unable to implement. Applicant should be responsible for all the consequences.
2)The application form and other correlative documents can be sent to CCICNA by fax, express mail or email. CCICNA will provide the inspection quotation to the applicant after all the application materials are received and accepted.
3)CCICNA will schedule the inspection with the applicant.
4)CCICNA mainly inspects the items which described on the part of Description of Inspection and issue certificate. Applicant should list the detail inspection items on the Application form.
5)Any demand for monetary compensation will be considered only if CCICNA’s gross negligence is proven. Under no circumstances CCICNA’s liability related to, arisen out of or based on an inspection conducted by CCICNA or its designated inspector(s) will exceed a total aggregate sum equal to five times the amount of the fee paid for the inspection, and any claims related to, arisen out of or based on such inspection must be adjudicated by Los Angeles court, California.
6)CCICNA reserves the right to reject application or issue certificate to applicant who provides false, inaccurate or incomplete information.
7)Attach another page if necessary.