EFTA00155069

CONFIDENTIAL



CF 157 749 071 AU



## 1. From (Sender)

<table border="1"><tr><td>Name</td><td>A CODELINE PEARCE</td><td>Company Name</td></tr><tr><td>Email</td><td>pearce456@gmail.com</td><td>Telephone No.</td></tr><tr><td>Address</td><td colspan="2">US STIRLING TCE</td></tr><tr><td>City/State/Postcode</td><td>KADINA</td><td>SA 5554</td></tr><tr><td>Country</td><td>AUSTRALIA</td><td></td></tr></table>





Address 1ST ANDREWS PLAZA



<table border="1"><tr><td>City/State/Postcode</td><td>NEW YORK</td><td>CITY</td><td>NEW YORK</td><td>10007</td></tr><tr><td>Country</td><td>AMERICA</td><td></td><td></td><td></td></tr></table>

<table><thead><tr><th colspan="2">Category Of Item (Tick ∨)</th><th>Documents</th><th>Gift</th><th>Commercial Sample</th><th>Returned Goods</th></tr></thead><tbody><tr><td></td><td></td><td>Merchandise</td><td>Other</td><td colspan="2">Reason For Export</td></tr><tr><td colspan="3">Full Description Of Goods</td><td>No. Of Items</td><td>Net Weight (kgs)</td><td>Value (AUD$)</td></tr></tbody></table>

CF 157 749 071 AU

<table><tr><td>AUSTRALIA</td></tr><tr><td>NORWOOD POST SHOP</td></tr><tr><td>11/04/2024 09:40 0067 02</td></tr><tr><td>0.090 kg ($)</td></tr><tr><td>To: USA</td></tr><tr><td>$21.00 GST Free</td></tr><tr><td>Postage Paid OS</td></tr></table>



6. Sender’s Authorisation

The sender acknowledges that this article may be carried by air and will be subject to aviation security and procedures - canage of the article is subject to the Australia Post Terms and Conditions available at www.ausspost.com.au or at a Post Office - they may be liable for any costs incurred by Customs, including customers or excise duty.

The sender declares: • the information provided in this customs declaration form is true and correct • the article does not contain any explosive or incendiary devices, dangerous goods (other than those permitted and specifically disclosed on this form) or items prohibited by legislation or bosseal or customs regulations.

Signature Of Sender: X

Article without this declaration signed will not be delivered.

## Instructions

## 6. Sender’s Authorisation And Signature

1. Please read the Australia Post Terms and Conditions applying to this service, available at www.auspost.com.au or at a Post Office.

2. Please press firmly with a ballpoint pen - you are making multiple copies.

3. Please write the destination city and country in ENGLISH, if you also wish to address the item in the language of destination, please attach a separate address directly to the package.

## 1. Extra Cover



Return By Most Economical Route Treat As Abandoned



<table border="1"><tr><td>Extra Cover* (Tick)</td><td>*For UPU purposes Extra Cover means Insured Value</td></tr><tr><td>Amount Of Cover (AUD$)</td><td></td></tr></table>

<table border="1"><tr><td colspan="2">Export Clearance No.**</td></tr><tr><td colspan="2">For Commercial Items Only</td></tr><tr><td>HS Tariff No.</td><td>Country Of Origin</td></tr><tr><td rowspan="3">852351</td><td>AU</td></tr><tr><td>AU</td></tr><tr><td></td></tr></table>

## Australia Post

Limitations Of Liability

Australia Post is not a common carrier and accepts no liability as such. The Warsaw Convention may apply to the carriage of goods under this service and exclude or limit Australia Post's liability for losses.

See the Australia Post Terms and Conditions at www.auspost.co.uk or at a Post Office

EFTA00155070



EFTA00155071