Provide complete shipment identification and tariff classification details to establish the baseline customs declaration record.
Master Bill of Lading (MBL) Number
House Bill of Lading (HBL) Number
Bill of Lading Type
Ocean Bill of Lading
Air Waybill (AWB)
Multimodal Transport Document
Express/Courier BL
Seaway Bill
Bill of Lading Date of Issue
Carrier Name
Vessel/Voyage or Flight Number
Port of Loading (POL)
Port of Discharge (POD)
Place of Delivery (Final Destination)
Container Number(s)
Seal Number(s)
Harmonized System (HS) Code & Tariff Schedule Details
Line Item Number | Product Description | HS Code (6-12 digits) | Tariff Schedule Version/Year | Declared Quantity | Unit of Measure | Unit Price | Total Line Value | ||
|---|---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | H | ||
1 | 1 | Industrial Pumps | 841370 | 2024 WCO | 50 | pieces | $250.00 | $12,500.00 | |
2 | 2 | Electronic Control Panels | 853710 | 2024 WCO | 10 | units | $1,200.00 | $12,000.00 | |
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Total Declared Customs Value
Currency Code
Incoterms 2020 Rule
EXW
FCA
CPT
CIP
DAP
DPU
DDP
FAS
FOB
CFR
CIF
Are you the Importer of Record (IOR)?
Importer of Record Tax ID/EORI Number
Nominated Importer of Record Name and Tax ID
Ultimate Consignee Name
Shipper/Exporter Complete Address
Document the specific reasons for customs detention and all identified discrepancies between declared and actual shipment details.
Date and Time of Detention Notification
Detaining Customs Authority & Location
Primary Reason(s) for Detention (Select all that apply)
HS Code Classification Dispute
Valuation Discrepancy
Missing or Incomplete Documentation
Country of Origin Verification
Intellectual Property Rights (IPR) Concern
Prohibited/Restricted Goods Suspicion
Security or Safety Inspection
Sanctions/Embargo Screening Hit
Quantity/Weight Discrepancy
Previous Compliance History
Random Examination Selection
Other
Detailed Description of Discrepancy Findings
Has a physical inspection been conducted?
Inspection Results and Observations
Severity of Discrepancy
Minor (clerical error, no revenue impact)
Moderate (revenue impact < 10% of declared value)
Major (revenue impact 10-50% of declared value)
Critical (revenue impact > 50%, potential fraud)
Risk Assessment Score (1 = Low Risk, 5 = High Risk)
Does this shipment have prior detention history within the last 12 months?
Provide Previous Detention Case Reference(s) and Resolution Status
I confirm that the discrepancy findings have been reviewed with the customs officer on site
Customs Officer Name and Badge/ID Number
Verify the availability and accuracy of all commercial and regulatory documents required for customs clearance.
Is the original Commercial Invoice available?
Commercial Invoice Total Value
Explain absence and provide alternative value evidence
Does the Commercial Invoice match the declared customs value?
Explain valuation difference and provide justification
Which supporting documents are currently available? (Select all that apply)
Packing List
Certificate of Origin
Bill of Lading (already provided)
Insurance Certificate
Technical Specifications/Data Sheet
Sanitary/Phytosanitary Certificate
Quality/Inspection Certificate
Fumigation Certificate
Import/Export License
Letter of Credit
Other
Upload Commercial Invoice (PDF format, max 10MB)
Upload Packing List (PDF format, max 10MB)
Is a Certificate of Origin required for this commodity?
Upload Certificate of Origin (PDF format, max 10MB)
Basis for COO exemption
Are there any concerns regarding document authenticity or forgery?
Describe authenticity concerns and supporting evidence
Document Verification Checklist
Document Type | Available | Accurate vs Declaration | Meets Customs Format | Deficiency Notes | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Commercial Invoice | |||||
2 | Packing List | |||||
3 | Certificate of Origin | Pending from shipper | ||||
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Have any documents been translated to the destination country's official language?
Upload Certified Translations (PDF format, max 10MB)
Calculate revised duty and tax obligations and propose a settlement plan for any penalties or fines assessed by customs authorities.
Original Declared Duty Amount
Recalculated Duty Amount (based on corrected classification/valuation)
Anticipated Duty Differential (Recalculated - Original)
Regulatory Fine or Penalty Amount Assessed
Fine Category
Administrative Penalty
Revenue Evasion Penalty
Procedural Violation Fine
Documentation Deficiency Fine
Security/Safety Violation Fine
Other
Proposed Settlement Action
Accept and Pay Immediately
Submit Administrative Protest
Request Voluntary Disclosure Settlement
Negotiate Mitigated Penalty
Request Payment Plan
Escalate to Legal Appeal
Is the client aware of and has approved the settlement plan?
Client Approval Date
Explain pending client approval status and expected timeline
Payment Breakdown & Timeline
Payment Component | Amount | Due Date | Payment Date | Payment Reference | Completed | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Revised Customs Duty | $2,500.00 | 7/15/2025 | ||||
2 | Administrative Penalty | $500.00 | 7/15/2025 | ||||
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Will a Duty Drawback or Refund claim be filed after resolution?
Describe Duty Drawback eligibility and planned filing date
Justification for Settlement Approach and Risk Mitigation Notes
Final review, legal consultation verification, and authorized sign-off by licensed customs broker or freight forwarder.
Has Global Trade Counsel or Legal Department reviewed this case?
Legal Counsel Name and License Number
Explain why legal review was not required or is pending
Does this case require escalation to senior management or compliance committee?
Describe escalation rationale and required approvals
Licensed Customs Broker Name
Customs Broker License/Registration Number
Brokerage Firm Name
Broker Review and Clearance Timestamp
Broker Certification Statements (Select all that apply)
I have verified all tariff classifications against current nomenclature
I have reviewed all discrepancy findings for accuracy
I confirm that supporting documents are authentic and complete
I have calculated duty recalibration to the best of my professional ability
I have obtained necessary client approvals for settlement plan
I attest that this submission is truthful and compliant with international trade regulations
Customs Broker Digital Signature & Clearance Authorization
Is a secondary supervisory sign-off required by firm policy?
Supervisory Customs Broker Digital Signature
Additional Comments and Resolution Summary
I confirm that all information provided in this form is accurate to the best of my knowledge and that I have retained copies of all supporting documentation in accordance with recordkeeping requirements
To configure an element, select it on the form.