Dock Receipt Template

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Print Form
DOCK RECEIPT
(2) EXPORTER (Principal or seller-name and address including ZIP Code)
(5) DOCUMENT NUMBER
(5A) B/L OR AWB NUMBER
(6) EXPORT REFERENCES
Zip Code
(3) CONSIGNED TO
(7) FORWARDING AGENT/ FMC NO.
(8) POINT (STATE) AND COUNTRY OF ORIGIN OR FTZ NUMBER
(4) NOTIFY PARTY (COMPLETE NAME AND ADDRESS)
(9) DOMESTIC ROUTING / EXPORT INSTRUCTIONS
(12) PRE-CARRIAGE BY
(13) PLACE OF RECEIPT BY PRE-CARRIER
(10) LOADING PIER / TERMINAL
(14) EXPORTING CARRIER
(15) PORT OF LOADING / EXPORT
(16) FOREIGN PORT OF UNLOADING (Vessel/Air Only)
(11) TYPE OF MOVE
11A. CONTAINERIZED (Vessel Only)
(17) PLACE OF DELIVERY BY ON-CARRIER
Yes
No
MKS. & NOS./CONT. NOS.
NO. OF PKGS.
DESCRIPTION OF PACKAGES AND GOODS in Schedule B detail
GROSS WEIGHT
MEASUREMENT
(19)
(20)
(22)
(18)
(21)
DELIVERED BY:
RECEIVED THE ABOVE DESCRIBED GOODS OR PACKAGES SUBJECT TO ALL THE
TERMS OF THE UNDERSIGNED’S REGULAR FORM OF DOCK RECEIPT AND BILL OF
LADING WHICH SHALL CONSTITUTE THE CONTRACT UNDER WHICH THE GOODS
ARE RECEIVED, COPIES OF WHICH ARE AVAILABLE FROM THE CARRIER ON
REQUEST AND MAY BE INSPECTED AT ANY OF ITS OFFICES.
LIGHTER _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TRUCK
ARRIVED- DATE_ _ _ _ _ _ TIME_ _ _ _ _
FOR THE MASTER
UNLOADED-DATE_ _ _ _ _ _ TIME_ _ _ _ _
BY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CHECKED BY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
RECEIVING CLERK
DATE_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
IN SHIP
PLACED
LOCATION_ _ _ _ _ _ _ _
ON DOCK
Print Form
DOCK RECEIPT
(2) EXPORTER (Principal or seller-name and address including ZIP Code)
(5) DOCUMENT NUMBER
(5A) B/L OR AWB NUMBER
(6) EXPORT REFERENCES
Zip Code
(3) CONSIGNED TO
(7) FORWARDING AGENT/ FMC NO.
(8) POINT (STATE) AND COUNTRY OF ORIGIN OR FTZ NUMBER
(4) NOTIFY PARTY (COMPLETE NAME AND ADDRESS)
(9) DOMESTIC ROUTING / EXPORT INSTRUCTIONS
(12) PRE-CARRIAGE BY
(13) PLACE OF RECEIPT BY PRE-CARRIER
(10) LOADING PIER / TERMINAL
(14) EXPORTING CARRIER
(15) PORT OF LOADING / EXPORT
(16) FOREIGN PORT OF UNLOADING (Vessel/Air Only)
(11) TYPE OF MOVE
11A. CONTAINERIZED (Vessel Only)
(17) PLACE OF DELIVERY BY ON-CARRIER
Yes
No
MKS. & NOS./CONT. NOS.
NO. OF PKGS.
DESCRIPTION OF PACKAGES AND GOODS in Schedule B detail
GROSS WEIGHT
MEASUREMENT
(19)
(20)
(22)
(18)
(21)
DELIVERED BY:
RECEIVED THE ABOVE DESCRIBED GOODS OR PACKAGES SUBJECT TO ALL THE
TERMS OF THE UNDERSIGNED’S REGULAR FORM OF DOCK RECEIPT AND BILL OF
LADING WHICH SHALL CONSTITUTE THE CONTRACT UNDER WHICH THE GOODS
ARE RECEIVED, COPIES OF WHICH ARE AVAILABLE FROM THE CARRIER ON
REQUEST AND MAY BE INSPECTED AT ANY OF ITS OFFICES.
LIGHTER _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TRUCK
ARRIVED- DATE_ _ _ _ _ _ TIME_ _ _ _ _
FOR THE MASTER
UNLOADED-DATE_ _ _ _ _ _ TIME_ _ _ _ _
BY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CHECKED BY_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
RECEIVING CLERK
DATE_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
IN SHIP
PLACED
LOCATION_ _ _ _ _ _ _ _
ON DOCK

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