單據(jù)樣例：出口十聯(lián)單第五聯(lián)副本

繳納出口貨物港務(wù)費(fèi)申請(qǐng)書
    十聯(lián)單第五聯(lián)副頁(yè)
    SHIPPER
     D/R NO.
     抬頭
    CONSIGNEE
     繳納出口貨物港務(wù)費(fèi)申請(qǐng)書
    NOTIFY PARTY
     A 第五聯(lián)
    副頁(yè)
    PRE-CARRIAGE BY XXXX PLACE OF RECEIPT
    OCEAN VESSEL VOY.NO. PORT OF LOADING
    PORT OF DISCHARGE PLACE OF DELIVERY
     FINAL DESTINATION FOR THE MERCHANT'S RETER-ENCE
    CONTAINER NO. SEAL NO. NO. OF CONTAINERS OR PKGS KIND OF PACKAGES: DESCRIPTION OF GOODS GROSS WEIGHT
     MEASUREMENT
    TOTAL NUMBER OF CONTAINERS OR PACKAGES (IN WORDS)) SAY ____________________ONLY
    CONTAINER NO.
     SEAL NO. PKGS
     CONTAINER NO. SEAL NO. PKGS
    RECEIVED CCCCCCCBY TERMINAL
    FREIGHT & CHARGE PREPAID AT
     PAYABLE AT PLACE OF ISSUE
    TOTAL PREPAID NO. OF ORIGINAL B/L THREE