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Import Commodity Clearance (ICC-L)

NTA ICC-L commodity clearance form for import

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IMPORT COMMODITY CLEARANCE
(Accomplish in 4 copies)
Importer/Consignee (Name, Address, Telephone No.):

Import Commodity Clearance No.

Date of Filing:

ICC-L
TIN:
License No.:

Customs Broker: (Name, Address, Telephone No.)

IShipper (Name, Address, Telephone No.):

Bill of Lading/Airway Bill No.
Vessel/ Air Carrier:

Approximate Date of Arrival:

Port(s) of Discharge:

Country of Origin:

Description of Commodity

Class/ Grade

Quantity

Unit of
Measure

Net Weight
Kg.

FOB Value
(US $)

Republic of the Philippines
NATIONAL TOBACCO ADMINISTRATION

I hereby certify that the information supplied
herein are true and correct of my own
knowledge and belief.

AGENCY

____________________________
(Date of Issuance)

Printed Name and Signature of Importer/
Authorized Representative

This is to certify that the goods declared above have
been found to conform with the regulations of this office.

Designation:
Atty. ROHBERT A. AMBROS
Officer-In-Charge
Regulation Department

Number

OFFICIAL RECEIPT
Date

Amount Paid

ROBERT L. SEARES, M.D.
Administrator

Valid within Sixty (60) days from date of issuance.
Remarks:
Not valid if altered and/or contains
erasures/obliterations.
 
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