| Box 1 |
Reference period |
| Box 2 |
Declaration type (arrivals/dispatches) |
| Box 3 |
Customs chamber code, to which INTRASTAT declaration is addressed |
| Box 4 |
Receiver - in case of arrival INTRASTAT declaration or Dispatcher - in case of dispatch INTRASTAT declaration |
| Box 5 |
Declaring third party |
| Box 6 |
Total invoice value in PLN |
| Box 7 |
Total statistical value in PLN |
| Box 8 |
Total number of items |
| Box 9 |
Item number |
| Box 10 |
Description of commodities |
| Box 11 |
Code of country of consignment - in case of arrival INTRASTAT declaration or Code of the country of destination - in case of dispatch INTRASTAT declaration |
| Box 12 |
Terms of delivery code |
| Box 13 |
Nature of transaction code |
| Box 14 |
Commodity code (CN8) |
| Box 15 |
Mode of transport code |
| Box 16 |
Code of the country of origin - in case of arrival INTRASTAT declaration |
| Box 17 |
Net mass (kg) |
| Box 18 |
Quantity in supplementary unit |
| Box 19 |
Invoice value in PLN |
| Box 20 |
Statistical value in PLN |
| Box 21 |
Person filling in the declaration |
