1.
Sender’s Name
Departure City
Company
Address
Postal Code
Phone

2.
Recipient’s Name
Arrival City
Company
Address
Postal Code
Phone

3.
Cuation

4.
Description
quantity
highway/air
Safety tips
Sender’s signature
Year month day Time
Seal of pick-up express company and signature of courier
PRESS HARD

5.
Weight kg DIM l W H = cm³
Service Charge
freight charge yuan/RMB
Payment charges to : sender / recipient / Cash monthly payment
insurance fee yuan/RMB Internal’s value yuan/RMB insurance rate
Total Amount yuan/RMB
Insurance Declaration / Indemnity Clauses:
No Five times / Seven times / ___times of the actual freight charges of this time
Yes The compensation of damaged inner items which had already been insured shall be paid
according to the real value of the items within their insured value.

6.
outer packing: sound / damaged
internals: Correct and sound incorrect or damaged
Agent’s information: ID number, telephone number
Recipient’s signature
Agent’s signature
Year month day time
Deliver’s signature

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