ORGANISATION NAMECOUNTRY CODEGRN NUMBER
GOODS RECEIVED NOTE / Accusé de Réception---[prenumbered]
DELEGATION/CONSIGNEE (LOCATION)RECEIVED FROM / reçu de
DATE OF ARRIVAL Date de réceptionDOCUMENT WELL RECEIVEDIF NO, SPECIFY
MEANS OF TRANSPORT Moyen de transportROADqWaybill n°:FLIGHT N°
RAILqWaybill n°/ CMR n°:REGISTRATION N°
AIRqAir Waybill n°:VESSEL
SEAqBill of Lading n°:
Handcarried byq
GOODS RECEIVED / Marchandises reçuesFOR FOOD INDICATE NET WEIGHTRECEIVED ACCORDING TO DOCUMENT AND RECEIVED IN GOOD CONDITIONS Reçu selon documents et en bonne conditionCLAIM Réclamation
CONSIGNMENT N°DESCRIPTION Code articleCOMMODITY TRACKING N° OR DONORNB. OF UNITS nb. colisUNIT TYPE/WEIGHT type d'unité/poidsWEIGHT (kg) Total (kg)
q
q
q
COMMENTS / Observations
DELIVERED BYDATEFUNCTIONNAME (IN BLOCK LETTER)SIGNATURE
RECEIVED BYDATEFUNCTIONNAME (IN BLOCK LETTER)SIGNATURE / STAMP