I, ________________, of ________________, do hereby certify that to the best of my knowledge and belief the substantial containers and holders mentioned in (the annexed invoice) (invoice No. ________ of ________, 19____) * are of the manufacture of ________________ and were exported from the United States at the port of ____________, per S.S. ________________ on __________, 19____, and that the same are being returned to the United States (empty) filled with ________) (holdings ______________).*
Shipper
* Cross out inapplicable words.
19 C.F.R. §10.7