| (To be submitted in duplicate to the Consumer Affairs Department along with invoices certified by Comptroller of Customs and Other Relevant Documents.) |
| Each cell in the table must be of: |
| Row height – 0.7cm, Column width – 2.3 cm. |
| Importer: | Commodity: |
| Supplier: | Brand: |
| Origin: | Total quantity: |
| Invoice No. & Date: | Entry No.: |
| Ship & Date of Importation: | Entry paid on: |
| Exchange Rate: |
| PRICES TO BE STATED PER IMPORT PACKAGE |
| Item name | | | | |
| Size of package | | | | |
| Quantity (Cases/boxes/bales) | | | | |
| C.I.F. VALUE (Invoice Currency) | | | | |
| C.I.F. St. Lucia (EC$) | | | | |
| Remittance 1% of Invoice Value | | | | |
| Local handling Charge 5% | | | | |
| Service Charge 6% | | | | |
| Customs Duty | | | | |
| Value Added Tax (Input) | | | | |
| Landed Cost (Excluding Input VAT) | | | | |
| Distributors Mark-up (Where applicable) | | | | |
| Max. Distributors Price | | | | |
| VAT (Distributors Output) | | | | |
| Max Distributors Price/VAT | | | | |
| Wholesale Mark-up | | | | |
| Max. Wholesale Price | | | | |
| VAT (Wholesale Output) | | | | |
| Max. Wholesale Price/VAT | | | | |
| Retail Mark-up | | | | |
| Max. Retail Price | | | | |
| VAT (Retail Output) | | | | |
| Max. Retail Price/VAT | | | | |
| Retail Price per unit/VAT | | | | |
| Checked by: |
| Date: |
| FOR OFFICIAL USE ONLY |
| Certified correct | Approved |
| Per: | Per: |
| Designation: | Designation: |
| Date: | Date: |