ProForma Invoice - FM135-2 - For Customs Use Only

Sep 21, 2026

ProForma Invoice template for customs use only, labeled FM135-2. Includes fields for ship-from and bill-to details, invoice number, date, tax ID, and shipment information such as number of packages, estimated weights, currency, and payment terms. Provides customs-specific sections for export reason, port details, country of origin, harmonized code, and product description for an exempt, non-infectious gDNA diagnostic specimen. Contains special medical laboratory shipment notes, tax/VAT rate guidance, subtotal and total placeholders, and a declaration with signature and date.

LanguageEnglish

CategoryInvoices

FormatPDF

Pages1

AccessFree to download

SHIP FROM

BILL TO / SHIP TO

SHIPMENT INFORMATION

ADDITIONAL INFORMATION FOR CUSTOMS

DESCRIPTION AND PRICING

SPECIAL NOTES, TERMS OF SALE

Declaration and Signature

ProForma Invoice: For Customs Use Only FM135-2 |
SHIP FROM:
Site Name: | | --- | | Address: | | City/State/ZIP: | | Country: | | Phone: | Page: 1 of 1 Date: __________________________________________________________ Invoice \#: ______________________________________________________ Tax ID \#: _______________________________________________________ | BILL TO: | | | SHIP TO: | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | For customs use only | | | Attn: Client Services-Invitae | | | | | | | Harmonized Code: 2934.91.00.00 | | | 1400 16th Street | | | | | | | | | | San Francisco, CA 94103 | | | | | | | Not for resale | | | USA | | | | | | | | | | Phone: (415) 374-7782 | | | | | | | | | | | | | | | | | SHIPMENT INFORMATION | | | | | | | | | | P.O. \#: | | Mode of Transportation: | | | N/A | | | | | P.O. Date: | | Transportation Terms: | | | N/A | | | | | Letter of Credit \#: | N/A | Number of Packages: | | | 1 | | | | | Currency: | US Dollars | Est. Gross Weight: | | | 1.0 lbs | | | | | Payment Terms: | N/A | Est. Net Weight: | | | 1.0 lbs | | | | | Est. Ship Date: | | Carrier: | | | | | | | | | | | | | | | | | | ADDITIONAL INFORMATION FOR CUSTOMS | | | | | | | | | | Reason for Export: | Research and Development | | | | | | | | | Port of Loading: | | Port of Discharge: | | | | | | | | Country of Origin: | United States of America | AWB/ | | | | | | | | | | | | | | | | | | DESCRIPTION
gDNA Specimen-Exempt, Non-Infectious Diagnostic Specimen | | UOM
EA | | UNIT PRICE
5.00 | | QTY
1 | TAX VAT | LINE TOTAL
5.00 | | Packed in compliance with IATA Exempt Human Specimen | | | | | | | | | | URGENT MEDICAL LABORATORY SHIPMENT.
Substance of human origin, containing no animal material, and not of tissue culture origin. Human material that was neither inoculated with, nor exposed to, infectious agents of agricultural concern, including zoonotic agents. No further processing.
Please expedite custom clearance of this medical package.
NO COMMERCIAL VALUE | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | SPECIAL NOTES, TERMS OF SALE | | | | | | Subtotal | | 5.00 | | DOES NOT CONTAIN ANIMAL PRODUCTS.
NO COMMERCIAL VALUE. VALUE STATED FOR CUSTOM PURPOSES ONLY. This collection kit DOES NOT contain hazardous materials.
Diversion contrary to U.S. law prohibited | | | | | | Subject to Tax | | 5.00 | | | | | | | | Tax/VAT Rate | | 10% | | | | | | | | Tax/VAT | | | | | | | | | | Shipping & Handling | | | | | | | | | | Insurance | | | | | | | | | | [Other] | | | | | | | | | | [Other] | | | | | | | | | | [Other] | | | | | | | | | | TOTAL | | | | | | | | | | | | | | I DECLARE THAT THE INFORMATION MENTIONED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. | | | | | | | | | | Signature: Date: | | | | | | | | | HEADQUARTERS & LABORATORY | 1400 16th Street, San Francisco, [CA 94103](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ |](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ www.invitae.com](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ |](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ IN THE US](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ |](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ clientservices@invitae.com](CA 94103 | www.invitae.com | IN THE US | clientservices@invitae.com | p:)[ |](CA 941

FAQs

What is this ProForma invoice template intended for?

It is intended for customs use only, as indicated by the document header and the “For customs use only” billing note.

Which shipment details are captured in the Shipment Information section?

It records shipment logistics such as P.O. details, transportation mode and terms, number of packages, currency, estimated gross/net weight, and placeholders for carrier and ship date.

What is the customs description included for the goods?

The description specifies a gDNA specimen exempt and non-infectious diagnostic specimen, with notes that it is an urgent medical laboratory shipment and has no commercial value.

Sep 21, 2026

Upload by Oliver Hayes