1. This document appears to be a shipping form containing information about an item being shipped. It includes fields for the sender's name and address, category of item, contents, weight, postage costs, instructions if undeliverable, and commitments regarding dangerous goods. 2. The form is filled out with information about a document or sample being sent. It lists the item contents and value, total weight and converted weight, main and added postage costs, and total postage plus VAT. 3. The sender commits to postal regulations and certifies the parcel does not contain dangerous or prohibited items, agreeing to pay return costs if undeliverable. Their signature, the date accepted by the post office, and delivery

1. 2.
Dlcfi vl, aflawl( Pflar ilflAItfl
1. Hgten, dia chingudi grli/Full name, address ofsender:
3. Loqi hing gfii/Categoryofitem:
fl Taitiqu/Documents
:
n M6uhdng/Sample :
4. N0i dung/Content:
NOi dung / Commodity descripjon
Ddn vi /
Unit
Sd lugng /
Quantity
Gi6 tri/
Value
Wtn0k /tDu
Tdng gi6 triflotal value
5. Ghi d5n'cia ngrrdi g[ri khi kh6ng phet dftr-c blru g[ri/ Sende/s intructions in case of
lllllllllllilllllllilllllillllllillffillllillllllllllllilllllllllllll
E,
011904 5 VN
Oirir )trlt
'14(
,ti / r i.,
Iri,,
I
E Quatoitt
n Loaikhac/Other
8. Khdi luvns/weight (KG):
Khdi luong thr.rc t6Meight:
Khdi ludng qui ddi/Converted weight:
9. Crldc/Postage:
- Cu6c chfnh/Main postage:
- Cudc dich vu cong them/Added postage:
(Ghi rO ten, cudc DV cong them)
o
E
o
o
o
l!
ri
oo
o
"5o
'D5
E
o
o
o(!
6
(.)
E
<o
=gofi'-Aetivery
EJ Cnuydn hoan / Return .. . E ttuy/cancet
instruction in item number5, I agreeto paythe costsforretuming.
7. Ngiygidgfrl/Postingtime,date: Chrky ngudig&i/Pig
Tdng cudcllotal postage:
Thud VAT/UAT:
Tdng sd tiin thu (Cudc+VAT)/
Total (Total postage+VAT):
,l0.
Ddu ngiy BG nhin gif/Date stamp of accepting PO
Chf hi GDV nhan/Signature of PO ofiicer
11. Ngiy
'i::i:' ' r
!::t I
Ngudi nhan/Ngudi duop uf quydn nhan r.
Signature of addressee/consigner
(Kf, ghi 16 ho.tCn)
6. Cam kit cia ngrldi gfll: TOi chdp thufn Mc Oi6u lnoan tqi mqtsauphi6u g0i va cam doan bLru g0! ney
khdng ch(a nhrng maihang nguy hi6m, cdm g&i. Trudng hop khong ihat dudc hey tht/c hi6n chld6n tai
muc 5, toi s6tr6 cudcchuydn hodn.
Sende/s committment: I accept all regulations given on the back olthis bill and certify that this parce!,"-
does not content any dangerous or prohibited article. ln case of non-delivery please kindly follow'my
,/)/ti,
i .a t)ttdnq 0'l(Clt S6ng Thfrn I'fi An{hh O$ng
lMstl gTooj
-----I
t
Itlffillllillllllllllllilllilllillllilflililllllllllllllillillillllllll
Et
firellf i:6- p-f,.'t ,-ld5. ellr+ rl"'r., ri: Llff" ,ttC6*;11i*" 0;" pt^r t?.p"1 &?Ii:(t ll-"r1, p,
'i,(l
(l
t^l-,
Sr * ;{rir,rr1liS6 tf"+, i,l -}i, #,g+it l.,,tt ilt,
-)t
(,
:Dlcn vy cflarEl Pflar t(flAnn
{. Hgt6n, ilia chi ngrldi g0l/Full name, address ofsender:
3. Lo?i hang gfll/Category of item:
E Tailieu/Documents
E MSiihang/Sample
4. N0i dung/Content:
NOi dung / Commodity description
Ddn vi /
Unit
Sd luong /
Ouantitv
Gi6 tr!/
Value
Oar
aI4.,.,Tr 'l.i
iI
Tdng gia trifTotal value
5. Chi din c&a ngrldi gfll khi kh6ng phat dud.c btn| gffl/ Sender's intructions in case of
non-delivefy
I Chuydn hodn / Return E Huy/cancel
Ep s? 01{809 I VN
2. Hg ten, ilia chi ngudi nhin/Full name, addless of receiver:
8. Khdi ludngMeight (KG):
Khdi lucmg thttc t6tlVeight:
Khdi lugng qui ddi/Converted weight:
L Crldc/Postage:
- Cudc chinh/Main postage:
- Cudc dlch w cong them/Added postage:
(Ghi 16 tcn, cuoc DV c0ng thcm)
+ ..............................
E oualon
E Loaikh6c/Other
o
E
E
o
a
o
o
u-
d
oo
o
.5
o
,5
5
o)
=o
E
o
o
.q
o
ri
c
:9
J
il
,l-: :
6. Cam k6t c0a ngrldi gfti: Tdi chdp thuin c6c di6u kho6n tai mdt sau phi6u g0i vd cam doan buug&i ndy
kh0ng chua nh[ng maihang nguy hidm, cdm g&i. Trudng hop kh6ng ph6trluo1c hdythrlc hi€n chidin tqi
Sende/s mmmittment: I accept all regulations given on the back of this billd -tff$ertity that this parCel
does not mntent any dangeroirs or piohibited article. ln case of,hon-delivbf!-please kindly follow my
instruction in item number5, I agree to paythe costsfor returning,
7. Ngey gidgfil/Posting time,date: Chrky ngudi g&i/Signalure ofsender
T6ng cudcfiotal postage:
Thu6VATITAT:
Tdng s6tiin thu (Cudc+VAT)/
Total (Total postagelvAT):
10. Ddu ngiy BC nhan gtf/Date stamp of accepting PO
Ch[ kf GDV nhin/Signature of PO officer
;_*: ,,/-"., 1
il I _-i /,-/-"t'
1'1. Ngiry gid nh6n/Time of delivery:
....... ........h.. ........./.............../......,..........
Ngrrdi nh6n/Ngudi duoc uf quy6n nhdn
Signature of addressee/consigner
(Kli, ghi ro hq tcn)
$U lhrn I'm An'Binh 0rlrsg
MST:3700232393