FROM:
Name and address of the sender:
   
TO: Delft Solids Solutions B.V., The Netherlands
Name and address of addressee
visiting address:
Rotterdamseweg 183C
2629 HD Delft
postal address:
(not for delivery services)
PO Box 1038
2600 BA Delft
CONTENTS:  
documents of no commercial value
samples of merchandise of no commercial value
Detailled description of the samples:
(see also our recommendation)
Additional Information:
Value (Euro or US Dollars):
Quantity:
Country of origin of the samples:
Country of destination:
Total gross weight
The undersigned certifies that the particulars in this declaration are correct and that the package does not contain any dangerous article.
Name:

 

signature:


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