EXPORT ENTRY DECLARATION A OFFICE OF DISPATCH / EXPORT

1 DECLARATION
Office code: P02B
2 Exporter/ Address TIN: Manila Intl Container Port
MITSUMI PHILS.INC. 000230682 EX1 1 Manifest :
Luzon Ave.,Phase 1, The Freeport 3 Page Export Declaration
Area of Bataan, Mariveles Bataan
Number: E 7876 Date: Sep 30, 2020
Philippines
2106 5 Items 6 Ttl Pckg. 7 Declarant Reference No.
xxxxxx 2020 UT5000193.
8 Importer/Consignee/ Address 9 Registry Office
CANON INC. TAIWAN AFAB
CHIAYI FACTORY NO. 46 YUANQU xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
1ST RD. DAMEI VIL DALIN TOWNSHIP
SHIAYI COUNTRY 622 TAIWAN R.O.C 10 11 12 13
xx xxxxx
14 Declarant/Address TIN: 15 Country of export 15 17 C.D. Code
Code
001221869 C.E.
YUSEN LOGISTICS PHILIPPINES INC. PHILIPPINES a PH b xx TW
NO 4 P. MAYUGA ST., MIA ROAD
16 17 Country of destination
PHILIPPINES TAIWAN, PROVINCE OF CHINA

18 Vessel/Aircraft: 19 Ct 20 Delivery Terms

JEJU ISLAND N112 1 FOB Free on board
21 Local carrier (if Any) 22 Cur. & Total amt. invoiced 23 Exch. Rate 24 FOREX
USD 34,576.63 48.545
25 26 27 Port of
28 Financial and banking data Bank Code: NA
Loading
1 PHMN2 Modes of Payment: 01
MANILA
INT'L.
CONTAINER
PORT
29 Port of Departure 30 Location
Bank name:
of goods
AFAB
Authority of
P02B Manila Intl Container Port Terms of Payment: NA
Freeport of
Bataan
31 Marks and numbers - Containers No(s)- Number and kind 32 Item 33 H.S. Code
Pack. Marks & no : 1X20FT. CONTAINER 1 No. 85044090 000
ages
of packages : 11,820 PIECES 34 35 Gr. mass kg 36
and Nbr & Kind : 8.00 PK
descr. PH xx 1,190.80 xxxxxxxx
iption 37 PROCEDURE 38 Net mass kg 39
of - - Other 1000 000 951.60 xxxxxx
goods
40
xxxxxxxxxxxxxxxxxxxxxxxxx
AC ADAPTOR
41 Suppl. units 42 Itm FOB Price 43 Val Method
44 Add Export Clearance No.: 34,576.63
infos - 45 Adjustment
Doc./ A.D.
produ.
Certif INV # 46 Statistical PHP value
& aut. Reference No. : 2020P02B E0007876 E 1,678,522.50
47 Cal Type Tax base Rate Amount MP 48 Prepaid Account 49 Identification of Warehouse
cula Number
tion B
of
Taxes Method of Payment: CASH
of Fees Assessment Number : L 7813 Date: Sep 30, 2020
Total Fees : 0.0
Total Assessment : 0.0
DATE/TIME Paid: 09-30-2020 11:04 AM 50 Declarant
DATE/TIME Allowed to Exit: 09-30-2020 11:34 AM
YUSEN LOGISTICS PHILIPPINES INC.

|2020P02BXE0007876e~
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

WHSU2746546 WHLJ988522
 MITSUMI PHILIPPINES, INC.
Luzon Avenue, Phase I, The Freeport Area of Bataan
Mariveles, Bataan, Philippines 2106
VAT REG. TIN 000-230-682-000

TEL NO : (047) 935-4011 to 15

FAX NO : (632) 731-1534 / (047) 935-5859
INVOICE
Invoice No : UT-5-000193 ( )
AND PACKING LIST
FBM No : 11732
DATE : 09/30/2020 0

Shipper/Exporter ORDER NO
MITSUMI PHILIPPINES, INC.
LUZON AVENUE, PHASE 1, FAB MARIVELES BATAAN TEL: (047) 935-4011 S/C NO

MESSR: MITSUMI ELECTRIC CO., LTD. L/C NO

2-11-2, TSURUMAKI, TAMA-SHI, TOKYO. 206-8567 JAPAN
PHONE : ISSUED BY
FAX NO :
EXPIRES ON
SHIPPED PER BOAT ON 10/04/2020
PICK-UP 09/30/2020
FROM MICP TO KAOHSIUNG VIA
NOTE
CONSIGNEE: CANON INC., TAIWAN
CHIAYI FACTORY NO.46, YUANQU 1ST RD. DAMEI VIL DALIN TOWNSHIP, SHIAYI COUNTRY 622,
TAIWAN R.O.C PHONE :
FAX NO. :
PAYMENT T/T WITHIN 60 DAYS
NOTIFY: CANON INC., TAIWAN
CHIAYI FACTORY NO.46, YUANQU 1ST RD. DAMEI VIL DALIN TOWNSHIP, SHIAYI COUNTRY 622, AFTER B/L DATE
TAIWAN R.O.C
PHONE : 886-5-2953888 (7213)

FINAL DEST'N: CANON INC., TAIWAN

CHIAYI FACTORY NO.46, YUANQU 1ST RD. DAMEI VIL DALIN TOWNSHIP, SHIAYI COUNTRY 622,
TAIWAN R.O.C
PHONE : 886-5-2953888 (7213)

Pkg Nos. Description Customer's Quantity Unit Price ( USD ) Amount ( USD )
Order No.
Model R Number Part No Material Processing Material Processing
AC ADAPTOR F.O.B.
SPS SPS
1 30 R 68-8240 H LC-E10E 682M312439 1,800PCS 2.15398 0.42254 3,877.16 760.57
31 35 CH-241JA/UC R 68-8241 F C51-0571-000 682M300012 300PCS 4.44613 0.55171 1,333.84 165.51
36 117 R 68-8247 C LC-E10 682M312496 4,920PCS 2.47954 0.44110 12,199.34 2,170.21
118 197 CH-242WW R 68-8242 P C51-0581-000 682M312348 4,800PCS 2.47954 0.45171 11,901.79 2,168.21

Sub-total : SPS SPS >> 11,820.0 29,312.13 5,264.50

TOTAL : 197 CARTONS 11,820.0 PCS TOTAL : 29,312.13 5,264.50

8 PALLETS ( 58.00 kgs 9.567 m3 )
INVOICE TOTAL : USD 34,576.63
G/W : 1,190.8 kgs N/W : 951.6 kgs VOLUME : 9.567 m 3
NOTE : MATERIAL SUPPLIED FROM OVERSEAS WITHOUT FOREIGN EXCHANGE
PACKING INSTRUCTIONS :
OTHER NOTIFY PARTIES : SHIPPING INFORMATION :

Marks and Nos.

MITSUMI PHILIPPINES, INC.
CANON
KAOHSIUNG
C/NO. 8 PLTS. (197 CTNS.)
MADE IN PHILIPPINES

AUTHORIZED SIGNATURE

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