1
?????????? (????????????, ??????, ??????)
Sender (name, address, country)
LLC Plandent Eesti O
Madara 27
Tallinn, 10142
Estonia
2
????????? (????????????, ??????, ??????)
Consignee (name, address, country)
16
?????????? (????????????, ??????, ??????)
Carrier (name, address, country)
PE YUZKIV MYKOLA VASYLOVYCH
SE TRANS-ATLAS
St. Sichovyh Striltsiv, 23
St. Elektroaparatna, 14
Zolochiv, 80700
Lutsk, 43000
Ukraine
Ukraine
3
????? ????????????? ???????
Place of delivery of the goods (place, country)
17
????????? ?????????? (????????????, ??????, ??????)
Successive carrier (name, address, country)
?????/Place
Zolochiv
??????/Country
Ukraine
4
????? ? ???? ???????????? ???????
Place and date of taking over the goods (place, country, date)
?????/Place
Tallinn
??????/Country
Estonia
18
?????????? ?? ???????????? ???????????
Carriers reservations and observations
????/Date
16 November 2022
5
?????????, ??? ?????????
Documents attached
Contract, INVOICE ?1 16 November 2022
EUR.1 ?1 16 November 2022
6
????? ?? ??????
Marks and Nos
7
????????? ?????
Number of packages
8
??? ?????????
Method of packing
9
???????????? ???????
Nature of the goods
10
??????? ?
Statistical number
11
???? ??????, ??
Gross weight in kg
12
????, ?
Volume in m
30 Case, car Dental chair
9402100000
8200
????
Class
?????
Number
??????
Letter
ADR
13
???????? ??????????? (????? ?? ???? ???????)
Sender's instructions
19
???????? ?? ??????
To be paid by:
??????????
Sender
??????
Currency
?????????
Consignee
??????
Carriage charges
??????
Deductions
???????
Balance
????????
Supplem
????????? ?????
Supplem. charges
????
Other charges
184525,17 euro
????? ?? ??????
TOTAL
14
??????????
Cash on delivery
15
????? ??????
Instructions as to payment for carriage
20
???????? ????????? ?????
Special agreements
??????
Carriage paid
EXW Tallinn
????????
Carriage forward
21
????????
Established in
Tallinn
????
on
16 November 2022
24
?????? ???????? ????
Goods received Place on
22
23
On 30 November 2022
??? ???????? ??? ????????????? 13:35 ??.
Arriving for unloading Min.
???????? 15:00 ??.
Leaving Min.
?????? ?? ????? ???????????
Signature and stamp of the sender
?????? ?? ????? ???????????
Signature and stamp of the carrier
?????? ?? ????? ??????????
Signature and stamp of the consignee
25
????????????? ?????/ Licence number of
?????/Tractor unit ???????????/Semitrailer
26
?????
????? ???????????