| 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 |
When filling in essential boxes, amongst other, catalogues containing following information are used: