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Commercial Invoice

COMMERCIAL INVOICE

Date: ___________

Page 1 of

Commercial Invoice #:
Reference / Purchase Order No:
FedEx Express Air Waybill Number:

Ship From

________________

Ship To

Name: _______________________________________

Name: Genomic Health Inc.

Address: _____________________________________

Address: 301 Penobscot Drive

City/State/Zip: _________________________________

City/State/Zip: Redwood City, CA 94063

Phone: ________________

Phone: 650-556-9300

Fax

Importer Other Than Recipient:

Fax: 650-556-1132

Check One:

Name: Same as Ship To

Country of Export: ____________

Address:

Country of Manufacture: USA

City/State/Zip:

Country of Destination: USA

Phone:

Currency: US Dollars

Fax:

Package Information
Unit of Type of No. of
Qty
Measure Pkgs. pkgs

Unit
Value

Commodity Description

Weight

Total
Value

Kgs

$__$7.00_USD

Human tissue (Non-Infectious) embedded in paraffin


block. Tissue is for Diagnostic Testing.
Laboratory Use only.

HS Description: Antisera and other blood


_

Ea.

Box

$__$7.00USD fractions and modified immunological products,

whether or not obtained by means of


biotechnological processes: Other

US Harmonized (HS) Code: 3002.10.0190

Total Number
of Packages

Signature of shipper/exporter (type name and title and sign)


I declare all the information contained in this invoice to be true and correct.
Destination Control Statement:

"These commodities, technology, or software were exported


from the United States in accordance with the export
administration regulations. Diversion contrary to U.S. law is
prohibited."

Total

Kgs

$7.00USD

Date:

FROM: Genomic Health, Inc.


301 Penobscot Drive
Redwood City, Ca 94063-4700
Ph: 650-569-2255
Fax: 650-556-1132
TO: US Department of Homeland Security
Bureau of Customs and Border Protection
Anchorage International Airport, Alaska U.S.A.
Dear Officer to whom this may concern:
Genomic Health, Inc. is willing to inform following answers regarding its shipment.
Federal Express AWB Number: __________________________________________
Q. Has the material in the shipment been exposed to livestock or avian disease agents
exotic the United States?
A. No, it hasnt.
Q. Does the material produce ANTIGENS or MONCLONAL ANTIBODIES directed
against livestock or avian disease agent?
A. No, it doesnt.
Q. Is the product (DNA, protein, etc.,) to be used IN VIVO or IN VITRO? If it is in VITRO,
please present an original statement on producer/shipper letterhead indication the
material is (1) for IN VITRO use and, (2) non-recombinant, or, if recombinant, with the
genetic inserts identified.
A. No, it isnt.
Q. Identify the Intended Use of the product.
A. Fixed Human Tissue embedded in paraffin for Analytical Testing
Q. Does the product contain monoclonal or polyclonal antibodies? What is the
immunogen?
A. No, it isnt purified antibodies
Respectfully yours,
____________________________________
Leslie Marquez
Director, Customer Service
Genomic Health Inc.
301 Penobscot Drive
Redwood City, CA 94063
Ph: 650-569-2438

Fax: 650-556-1073
lmarquez@genomichealth.com