This form contains 132 fields organized into 29 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Bill of Lading Details
Point and Country of Origin Text
Please enter the point and country where the shipment originated.
Forwarding Agent FMC No. Text
Please enter the Federal Maritime Commission (FMC) number of the forwarding agent.
Quote No. Text
Please enter the quote number associated with this bill of lading.
Export References Text
Please provide any relevant export reference numbers or details for the shipment.
Bill of Lading / PO No. Text
Please enter the Bill of Lading number or the Purchase Order number for this shipment.
Booking No. Text
Please enter the booking number assigned to this shipment.
Date Shipped Date
Please enter the date on which the shipment was dispatched.
Charge Totals
Total Collect Number
Provide the total amount for charges that are to be collected.
Total Prepaid Number
Provide the total amount for charges that have been prepaid.
Charges To Be
Third Party Radiobutton
Check this box if the charges for this shipment are to be billed to a third party.
Prepaid Radiobutton
Check this box if the charges for this shipment have been paid in advance by the shipper.
Collect Radiobutton
Check this box if the charges for this shipment are to be collected from the consignee upon delivery.
COD Amount
COD Amount Number
Please enter the Cash on Delivery amount.
TextField1 Text
Consignee Information
Consignee Full Details Text
Provide the complete name, address, and any other relevant details for the consignee, as this is where the goods will be delivered.
Consignee Phone Number Text
Enter the contact phone number for the consignee.
Declared Value
Declared Value Number
Please provide the declared value of the shipment in US dollars.
Insured Value Amount Number
Please provide the insured value of the shipment if it is greater than the declared value.
Per Package Radiobutton
Check this box if the insured value is declared on a per package basis.
Kilogram Weight Radiobutton
Check this box if the insured value is declared on a per kilogram weight basis.
Shipper Initials for Additional Insurance Text
Please provide the shipper's initials to acknowledge responsibility for additional insurance for personal effects.
Delivery Information
Delivery To Address Text
Enter the complete name, address, and ZIP code for the delivery recipient.
Delivery Phone Number Text
Provide the phone number for the delivery contact.
Driver's Signature
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Fifth Charge Item
Fifth Charge Amount Number
Enter the charge amount for the fifth charge item.
Fifth Charge Prepaid Amount Number
Enter the prepaid amount for the fifth charge item.
Fifth Charge Collect Amount Number
Enter the collect amount for the fifth charge item.
Fifth Charge Basis Number
Enter the basis for the calculation of the fifth charge item.
Fifth Charge Rate Number
Enter the rate applied for the fifth charge item.
Fifth Item Description
Number of Packages Number
Enter the total number of packages for this item.
Marks and Container Numbers Text
Enter the marks and container numbers for this item.
Description of Package and Goods Text
Provide a detailed description of the package and the goods contained within for this item.
Gross Weight Number
Enter the gross weight for this item.
Measurements Text
Enter the measurements for this item, including dimensions and units.
Hazardous Material Indicator Text
Enter 'X' if this item is designated as hazardous material, otherwise leave blank.
Freight Class Text
Enter the freight class for this item.
First Charge Item
First Charge Amount Number
Please enter the amount for the first charge item.
First Charge Prepaid Amount Number
Please enter the prepaid amount for the first charge item.
First Charge Collect Amount Number
Please enter the collected amount for the first charge item.
First Charge Basis Number
Please enter the basis for the first charge item.
First Charge Rate Number
Please enter the rate for the first charge item.
First Item Description
Number of Packages Number
Enter the total number of packages for the first item.
Marks and Container Numbers Text
Provide the identifying marks and container numbers for the first item.
Description of Package and Goods Text
Describe the package and goods for the first item.
Gross Weight Number
Enter the gross weight for the first item.
Measurements Text
Provide the dimensions or total measurements for the first item.
Handling or Material Code Text
Enter the handling or material code for the first item, if applicable.
Freight Class Number
Provide the freight classification for the first item.
Fourth Charge Item
Fourth Charge Item Charges Number
Enter the amount for the fourth charge item.
Fourth Charge Item Prepaid Number
Enter the prepaid amount for the fourth charge item.
Fourth Charge Item Collect Number
Enter the amount to be collected for the fourth charge item.
Fourth Charge Item Basis Text
Specify the basis for the fourth charge item.
Fourth Charge Item Rate Number
Enter the rate for the fourth charge item.
Fourth Item Description
Number of Packages Number
Enter the total number of packages for the item.
Marks and Container Numbers Text
Enter the marks, numbers, and container numbers for the item.
Package and Goods Description Text
Provide a detailed description of the package and goods.
Gross Weight Number
Enter the gross weight of the item.
Measurements Text
Enter the measurements or dimensions of the item.
Hazardous Material Text
Enter 'X' if the item is classified as hazardous material.
Freight Class Text
Enter the freight classification for the item.
Insured Value
Or Entire Shipment Radiobutton
Check this box if the declared insured value applies to the total value of the entire shipment.
Insured Value Greater Than Number
Enter the insured value if it is greater than the declared value.
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Issuance Information
Issued At Location Text
Enter the location where this document was issued.
Issued On Date Date
Enter the date this document was issued.
Issued By Text
Enter the name of the person who issued this document.
Method of Payment
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topmostSubform[0].Page1[0].topmostSubform_0_\.Page1_0_\.ValueOf_0_[0]_Kilogram RadioButton
topmostSubform[0].Page1[0].topmostSubform_0_\.Page1_0_\.ValueOf_0_[0]_Or#20Entire#20Shipment RadioButton
Notify Party Information
Notify Party Name and Address Text
Please provide the complete name, address, and ZIP code of the party to be notified.
Notify Party Phone Number Text
Please provide the phone number of the party to be notified.
Second Charge Item
Second Charge Item Charge Amount Number
Enter the total charge amount for the second charge item.
Second Charge Item Prepaid Number
Enter the prepaid amount for the second charge item.
Second Charge Item Collect Number
Enter the amount to be collected for the second charge item.
Second Charge Item Basis Text
Enter the basis used to calculate the second charge item.
Second Charge Item Rate Number
Enter the rate applied for the second charge item.
Second Item Description
Number of Packages Text
Please enter the total number of packages for this item.
Marks and Container Numbers Text
Please enter the marks and container numbers for this item.
Package and Goods Description Text
Please provide a detailed description of the package and goods for this item.
Gross Weight Number
Please enter the gross weight of this item.
Measurements Text
Please enter the dimensions or volume measurements for this item.
Handling Method/Unit Text
Please enter the specific handling method or unit of measure for the number of packages.
Freight Class Text
Please enter the freight class for this item.
Seventh Charge Item
Seventh Charge Item Charges Amount Number
Enter the total charge amount for the seventh charge item.
Seventh Charge Item Prepaid Amount Number
Enter the amount of the seventh charge item that has been prepaid.
Seventh Charge Item Collect Amount Number
Enter the amount of the seventh charge item to be collected.
Seventh Charge Item Basis Text
Enter the basis used for calculating the seventh charge item.
Seventh Charge Item Rate Number
Enter the rate applicable to the seventh charge item.
Seventh Item Description
Number of Packages Text
Enter the total number of packages.
Marks & Nos Container Nos Text
Enter the marks and container numbers for the items being shipped.
Description of Package and Goods Text
Provide a detailed description of the packages and goods being shipped.
Gross Weight Number
Enter the total gross weight of the shipment.
Measurements Text
Enter the measurements of the shipment.
Hazardous Material Designation Text
Enter 'X' if the material is hazardous as defined in Title 49 of Federal Regulations.
Freight Class Text
Enter the freight class for the shipment.
Shipment Route Information
Number of Originals Text
Enter the total number of original documents issued for this shipment.
Loading Pier/Terminal Text
Enter the pier or terminal where the goods will be loaded.
Place of Delivery by On Carrier Text
Enter the specific location where the goods will be delivered by the final carrier.
Port of Discharge Text
Enter the port where the goods will be discharged from the main vessel.
Port of Loading Text
Enter the port where the goods will be loaded onto the main vessel.
Place of Receipt by Pre-Carrier Text
Enter the specific location where the goods were received by the pre-carrier.
Pre-Carriage By Text
Enter the method or company responsible for the pre-carriage leg of the shipment.
Export Carrier Text
Enter the name of the export carrier, including vessel, voyage number, or flag if applicable.
Shipper/Exporter Information
Shipper/Exporter Details Text
Please provide the complete name, address, and zip code of the shipper or exporter.
Shipper Phone Number Text
Please enter the phone number of the shipper.
Sixth Charge Item
Sixth Charge Item Text
Please enter the description of the sixth charge item.
Sixth Charge Prepaid Number
Please enter the amount that has been prepaid for the sixth charge item.
Sixth Charge Collect Number
Please enter the amount to be collected for the sixth charge item.
Sixth Charge Basis Text
Please enter the basis for calculating the sixth charge item.
Sixth Charge Rate Number
Please enter the rate applicable to the sixth charge item.
Sixth Item Description
Number of Packages Text
Please provide the total number of packages for this item.
Marks & Container Numbers Text
Please provide the marks and container numbers for this item.
Description of Package and Goods Text
Please provide a detailed description of the package and the goods contained within.
Gross Weight Number
Please enter the gross weight of this item.
Measurements Text
Please provide the dimensions or volume measurements for this item (e.g., L x W x H or cubic feet).
Hazardous Material Indicator Text
Please indicate if this item is hazardous material (e.g., 'X' if yes).
Freight Class Text
Please enter the National Motor Freight Traffic Association (NMFTA) freight class for this item.
Third Charge Item
Third Charge Item Charges Number
Enter the charge amount for the third item.
Third Charge Item Prepaid Amount Number
Enter the prepaid amount for the third charge item.
Third Charge Item Collect Amount Number
Enter the amount to be collected for the third charge item.
Third Charge Item Basis Text
Enter the basis used for calculating the third charge item.
Third Charge Item Rate Number
Enter the rate applicable to the third charge item.
Third Item Description
Number of Packages Number
Please enter the total number of packages for this item.
Marks and Container Numbers Text
Please enter the identifying marks and container numbers for this item.
Description of Package and Goods Text
Please provide a detailed description of the package and the goods contained within this item.
Gross Weight Number
Please enter the total gross weight of this item.
Measurements Text
Please enter the dimensions or other relevant measurements for this item (e.g., length x width x height).
H/M (Handling/Measuring) Text
Please enter any specific handling instructions or measurement codes (H/M) for this item.
Freight Class Number
Please enter the freight class for this item.
Third Party Billing Information
Third Party Billing Name and Address Text
Enter the complete name, address, and ZIP code of the third party responsible for billing. Fill only if 'Third Party' is 'Yes'.
Depends on: Third Party
Third Party Phone Number Text
Provide the phone number for the third party responsible for billing. Fill only if 'Third Party' is 'Yes'.
Depends on: Third Party