1. This appears to be a document related to shipping or mailing an item. It includes fields for sender information, recipient information, item category, description, quantity, value, postage costs, delivery instructions, and signatures. 2. The item being mailed is described as documents/samples, with details about the contents, unit, quantity, and total value. 3. Instructions are provided for returning the item if undeliverable, and the sender agrees to accept regulations and ensure the item does not contain dangerous/prohibited materials.

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1. Hgt6n, dla$lngudlgltl/Fullname, ddt€ss of sondor:
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3. l49l hing gol/Cabgory of ibm:
1J Tdili6uDocuments
E Me-u heng/Sample
4. NQI dung/Content:
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Oud/Gift
Loai khec/Other
Noi dung / Commodity description
Don vi /
Unit
36 luqng /
Quantity
Gia fi/
Value
Tdng gia triffotal value
5. Chl dfn c0a ngrtdi g0i ldi kh6ng ph5t ttroc buu g0i/ Sender's intructions in case of
non-delivery
Chuydn hodn / Retum .i I H0y/cancel
6. Cam k6l oia ngrtiti grli: T6i chi{p thuQn cac di6u khoin tqi mqt sau phi6u gii vd cam doan bttu g8i ndy
khdng ch0a nh0ng mdt hdng nguy hidm, cdm gti. Trudng hqp khOng ph6t fiJqc hAy thuc hien chi din tai
muc 5, t6i s6 td cudc chuydn hodn.
Sendels committrnent I accept all regulations given on he back ofhis bin and cerfiry illat his parcd
does not content any dangerous or prohibited artide. ln c*e of rbrFdelivery dease kindly follow rry
instruction initemnumbers, I agreebpaytrecostaforretuming.
7, Ngqy gid gni/Posting time,date: Chil ky ng'Jdi gfii/Signature of Sendet
DlCfl Vl' qrayEN PrrAr MraNfl
1. Hot6n, diadringrrdi g&i/Full name, addressofssndar:
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Tdng cu6cffotal postage:
ThugVATrlr'AT:
Tdng s6ti& tru (Cu6c+VAT)/
Total (Total
10. D6"u
chr ky
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Ngudi nhan/Ngudi dugc 0y quydn nhan
Signature of addressee/consigner
(Ki,, ghi 16 ha ten)
accepting P.O
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3. Loqi hdng g0i/Cat€goryof item:
L l larlreu/uocumenE
I ll]a'unirng/Sample
4. NQi dung/Content:
Noi dung / Commodity description
Ddn vi /
Unit
Sd ludng /
Quantity
Gie tri/
Value
.Arh. tt{,(
Tdng gi6 tri,Total value
5. Chj,da"n cia ngUdi gii ldri ldr6ng phat duqc buu grli/ Sender's intructione in case of
qdn-delivery
VCnrydnhoin/Return I Hiy/Cancet_T
6.Eam k6t cua ngudi g&i: Toi chdp thuin c6c di6u khoan tai m6t sau phi6u gti vd cam doan buu gii ndy
kh6ng chia nhrlng m{t hdng nguy hidm, cdm g0i. Trudng hdp kh6ng phat dugc hey thrlc hi6n chi dfn tai
mqc 5, t6i sA tra cudc chuydn hodn.
Sender's committment; I accept all regulations given on the back of this bilt and certiry that flris parcel
does not content any dangerous or prohibited article. ln case of non-delivery please kindly follow my
inskuction in item number5, I agreeto pay the cosFforreturning.
7. Ngdy gid gtll/Posting time,date: Ch0 ki ngudi g0i/Signature of Sender
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TX.DTAn. T.Binh Drlcno. Viet Nam $J +;;;,ri-1, 0tl Cru 'i;f r""S,:. -i{Ufl;"i-r.i"-"-
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8. Khdi lugnglwelght (Kc):
Khdi luorE hrJc t6/vbight:
KhS luOng qui dd/Converted weight:
9. Cr.l6c/Fostage:
- Cu6c chinh/Main postage:
- Crtdc drch vu c6ng them/Added postage:
(Ghi ro ten, cu6c DV cong thCm)
Lture of'PO ofii
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HF S? 100004 2 VN
2. Ho i6n, dia dri ngrtdi nh{n/Full nam€, addro$ of lecaivor:
8. Kh6i luongMeight (KG):
Khtii ludng thuc t6,^iveight:
Kheii luong qui dd/Converted weight:
9. Cu6c/Postage:
" Cudc chinh/Main postage:
- CrJdc drch vu cong them/Added postagd
(chi ro ten, cLldc DV c6ng them)
+
Tdng clldc/Total postage:
ThudVAT/VAT:
Tdng sdtian thu (Cu6c+VAT)/
Total (Total postage+VAT):
10. Di'u ngdy BC nhQn g0l/Date
Ngudi nhan/NgLldi duqc 0y quy6n nhfln
Signature of addressee/consigner
(Ki,, ghi 16 hq t6n)
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