EXPORT ENTRY DECLARATION OFFICE OF DISPATCH / EXPORT

1 DECLARATION
Office code: P02B Manila Intl Container Port
2 Exporter/ Address TIN: 005242796000
TRANSITIONS OPTICAL EX3 1 Manifest Number:
PHILS.INC. 3 Page 4 Export Entry
CORNER STAR AVENUE
Number: -21018 Date: Oct 05 2020
MAMPLASAN, BINAN
LAGUNA 5 Items 6 Ttl Pack 7 Declarant Reference No.
2005-03668-04 1 10.0 2020 100520TOISEA
8 Importer/Consignee/ Address 9 Registry Office
ESSILOR OF AMERICA-Columbus Laguna International Industrial Prk
Distribution Center xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
2400 Spiegel Drive Suite A
Groveport, OH 43125 10 11 12 13
xx xxxx
17 C.D.
14 Declarant/ Address TIN: 000412149000 15 Country of Export 15 C.E. Code
Code
SKYFREIGHT BROKERAGE, INC. PHILIPPINES a PH b xx US
Brgy.Sto.Nino,Ninoy Aquino Ave.,
Paranaque City 16 17 Country of Destination
NAIA CBL#01-02(C)POM#02-004
MICP#02-002 PHILIPPINES UNITED STATES
18 Vessel/Aircraft: 19 Ct 20 Delivery Terms
MOL SUCCESS V.
1 FCA Free carrier
112N
21 Local carrier (if Any) 22 Cur. & Total Amt. Invoiced 23 Exch Rate 24
SKYFREIGHT USD 151,224.76 1.0
25 No. of LCL 26 No. of FCL 27 Port of Loading 28 Financial and Banking Data Bank Code: 998

xx PHMN2 MANILA INT'L.

1 Terms of Payment: 01 Basic
CONTAINER PORT

29 Port of Departure 30 Location of goods Bank name:

P02B Manila Intl Container Port LAG LAGUNA Branch Bank Ref. No:
31 Packages Marks and Numbers - Containers No(s)- Number and kind 32 Item 33 H.S. Code
and Desc. of Marks & no : AS ADDRESSED 1 No. 90015000 000
Goods
34 35 Gr. mass kg 36
of packages : 10 PALLETS / 50480 PIECES
Nbr & Kind : 10 PACKAGE PH xx 4,190 xxxx
38 Net mass
Containers no(s): 37 PROCEDURE 39
kg
GCXU2256490 1000 000 3,898 xxxx

40 AWB / Bill of Lading

- Spectacle lenses of other materials 42 Itm FOB

41 Suppl. units 43 Val Method
Plastic Optical Photochromic Lenses Price
44 Add Infos/ Export Clearance No.: PCE 50,480
151,224.76
Doc/Produ
Certif & Aut A.D.
45 Adjustment
INV #
Reference No.: X-LIIP-021018-20-E 46 Statistical PHP Value
47 Calculation Type 49 Identification of
Tax base Rate Amount MP 48 Prepaid Account Number
of Taxes of Warehouse
Fees B
Method of Payment: CASH
2020-10-05
Assessment Number : R 3233611 Date:
09:21:47.0
Total Fees :
Total Assessment :
DATE/TIME Approved 10/05/2020 09:21:58 AM 50 Exporter/Declarant
DATE/TIME Allowed to Exit: 10/05/2020 09:51:58 AM
TRANSITIONS OPTICAL PHILS.INC.

|2020ZLIIPEP021018=~
Printed Name and Signature of Declarant

Place and Date

51 AUTHORIZATION 52 Bureau of Customs (BOC) Control
Name of Agency :
Printed Name/ Signature Position
Printed Name / Signature Position
Date
Date Valid Until
53 INTERNAL REVENUE (TAX PER BOX # 46 & 47)

Taxable Value Php WHARFAGE Php OTHERS

Bank Charges:
Arrastre Charges: Total Landed Cost Php
Customs Duty:
Brokerage Fee: Documentary Stamp: Total VAT Php

Description In Tariff Terms, Should Be

54 Section 55 No of Packages Examined EXAMINATION RETURN 56 Date Received 57 Date Released

ITEM TARIFF
58. DESCRIPTION IN TARIFF TERMS SHOULD BE QTY UNIT UNIT VALUE RATE
NO HEADING

Decl

Fdgs

%Diff

PLEASE REFER TO RIDER/S FOR FINDINGS ON OTHER ITEMS

REVISED CHARGES LIQUIDATION

59 Charges 60 Declaration 61 Findings 62 Differences 65 Liquidated Amount

Duty PHP

BIR Taxes 66 ShortExcess

VAT PHP

Excise/ad valorem 67 Remarks

Others

Surcharges

TOTAL

64 68
63 Action Directed/Recommended
Date COO III COO III Date
69
Date COO V COO V Date

Continuation from Box #31 FREE DISPOSAL

PEZA - AEDS : X-LIIP-021018-20-E
Enterprise Name: TRANSITIONS OPTICAL PHILS.INC.
Zone: Laguna International Industrial Prk
Approved Date/Time: 10-05-2020 09:21:58 AM Allowed to Exit: 10-06-2020 09:21:58 AM

Port of Loading MANILA INT'L. CONTAINER PORT

Cargo Type Qty Amount Debit Date Payment Ref No.

FCL 1 225 10-05-2020 PHEAD 2020 P 3200060

Container Numbers PEZA Seal Numbers

1) GCXU2256490/PHAA83277 05416299
Container Numbers PEZA Seal Numbers
 VASP PAYMENT TRANSACTION ACKNOWLEDGMENT RECEIPT

Locator : TRANSITIONS OPTICAL PHILS.INC.

Broker : SKYFREIGHT BROKERAGE, INC.
Transaction Reference No. : X-LIIP-021018-20-E
VASP Pre-Payment Account Used : EK00007800 - SKYAIREXPORT
VASP Acknowledgment No. : 20200008485959
E-Konek TIN No. : 225-069-299-000
Payment Date : 10/05/2020 09:21 AM
Total VASP Fee : 45

This serves as your Acknowledgment Receipt for E-Konek VASP Transaction Fee
payment.