HQ/2009-TC

HI QUAN VIT NAM

(Bn lu ngi khai hi quan)

T KHAI HNG HO NHP KHU

HQ/2009-TC

A.PHN K KHAI V TNH THU CA NGI XUT KHU, NGI NHP KHU
1.Ngi xut khu:

5. Loi hnh NK:

NSX

MYANMAR TALENT GROUP COMPANY LIMITED

6.Giy php NK:

S:
Ngy:
Ngy ht hn:

7.Hp ng NK:
S: MTG/CM005/2011
Ngy:28/6/2011
Ngy ht hn:

No.310 Hoom No.202 (2nd FL). Anawrahta Rprd,

Lanmadow Township, Yongon, Myanmar
Tel: 95-1-220093,21362 Fax: 95-1-229971
2.Ngi nhp khu:

CONG TY TNHH CHAU MINH( CHAU MINH CO.,LTD.)

235/22 LE DUC THO ST, WARD 17, DISTRICT GO VAP,
HOCHIMINH CITY, VIETNAM
3.Ngi ch nh giao hng:

17. Tn hng
Qui cch phm cht

BLACK MATPE
( S.Q 2011 CROP)

14.iu kin giao

hng : FOB

18. M s
hng ho

19. Xut x

10.Vn ti n
S:
Ngy:

Ngy: 5.10.2011
11. Nc xut
khu: MYANMAR

4.Ngi lm th tc hi quan:

S
TT

8. Ha n thng 9.Phng tin vn

mi
ti: ng bin
S:
S: MTG100/2011 Ngy

12.Cng a im
xp hng:
YANGON,
MYANMAR

13. Cng a im
d hng:
HOCHIMINH(CATL
AI),VIETNAM

15. ng tin thanh ton: USD

T gi tnh thu: 20.803
16. phng thc thanh ton: L/C

20. Lng
n v tnh G nguyn tTG nguyn t

MYANMAR

125

MTS

125

S
TT

24.Thu nhp khu

Thu
sut
(%)

0%

Tr gi tnh thu
(VN)

111250

25.Thu GTGT (hoc TTB)

Tin thu

Thu sut (%)

Tr gi tnh thu
(VN)

26.Thu khc
Tin thu

T l
(%)

111250

2
3
4

Cng:
27.Tng s tin thu v thu khc ( 24+25+26): Bng s: ......111250.(USD)............................................................................. ....................
Bng ch: .MT TRM MI MT NGN HAI TRM NM MI NGN USD CHN......................................................................

S tin

28. Chng t xut khu km theo: Bn chnh

- Hp ng thng mi:
- Giy php:
- Ho n VAT:

Bn sao

29. Chng t nhp khu km theo: Bn chnh

- Hp ng thung mi
- Giy php
1
- Ho n thng mi:
1

Bn sao
1
1

B- PHN DNH CHO HI QUAN LM TH TC NHP KHU

Tng cc Hi quan
Cc Hi quan: ............................
Chi cc Hi quan: ......................

T khai s: ............./NK/........ -TC./.........

Ngy ng k: .........................................
S lng ph lc t khai: .........................

Cng chc ng k (k, ng du s

hiu cng chc)

I. Phn Hi quan kim tra thc t hng ho

30. Phn ghi kt qu kim tra ca Hi quan
Ngi quyt nh hnh thc kim tra: (ghi r h tn, ng du s hiu cng chc)
Hnh thc kim tra:

Min kim tra

Kim tra xc sut. T l: ..%

Kim tra ton b

a im kim tra:
Thi gian kim tra: T.. gi. , ngy
n: .gi , ngy
Kt qu kim tra:....................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................
31. i din doanh nghip nhp khu ti ch (k, ghi r h tn)

32. Cng chc kim tra thc t hng ho (k, ng du s hiu cng
chc)

II. Phn Hi quan kim tra thu

S
TT

33. M s hng ho

34. Lng

35. n gi
tnh thu

36. Tin thu nhp khu

Tr gi tnh thu
(VN)

Thu sut
(%)

Tin thu

1
2
3

S
TT

37. Tin thu GTGT (hoc TTB)

Tr gi tnh thu
(VN)

Thu
sut (%)

Tin thu

38.Thu khc
T l (%)

S tin

39. Tng s tin phi iu chnh sau khi

kim tra (Tng/Gim):
Bng s: .....................................
Bng ch:

1
2
3

40.Tng s thu v thu khc phi np ( 25+36): ...................................................... Bng ch :........................................... .......................
Thng bo thu/Bin lai thu thu s: ....................................................................Ngy................................................................................
41.L ph hi quan: ..................................................Bng ch: .............................................................................. ................................
Bin lai thu l ph s: ...................................... .........Ngy :.....................................................................................................................
42.Cng chc kim tra thu (k, ghi
r, ngy, thng, nm, ng du s
hiu cng chc)

43.Ghi chp khc ca hi quan

44. Xc nhn lm th tc hi quan (k, ng du s hiu

cng chc)