Tanzania Revenue Authority United Republic of Tanzania

2.Exporter/Consigner Name & Address TIN: 1.Declaration Type A.Office Of Departure Registration Number & Date

SMALL EXP T1 RUSUMO TZRU20200021577 05/12/2020

3.No Items Transit Type Declaration Reference Number

2 RW0020C021340

9.Importer/Consignee Name & Address TIN: 8.Country of Export 10.Country of Destination

Namp;T PLASTIC BOTTLES 105405488 TZ United Republic of Tanzania RW Rwanda

18.No Pckg 19.Gross Weight 20. Net Weight

12 () 10,200.0 (Kgs) 10,200.0 (Kgs)

14.Declarant/Agent Name & Address TIN:

SAMI AGENCIES LTD. 106691630

P.O.BOX 38545 DAR ES SALAAM

Ref.No. & Date 1066916302020T0000897 05/12/2020

23.Transport Mode 24.Cargo Ref. No (CRN) 25.Identity of Transport 29.Loading Place 31.CNTR

3. Road transport 20SCTTZRUC40053 COT/00749/2020 TZDAR

33.Item No. 34.Commodity Code 43.Gross Weight(Kgs) 44. Net Weight(Kgs) 50. Quantity

1 3901.90.00.0000 9,200.0 (Kgs) 9,200.0 (Kgs) 9,200 (KGM)

39.Description of goods 40.Proceding Doc.

- Other polymers of ethylene, in primary forms- Other polymers of ethylene, in

primary forms

33.Item No. 34.Commodity Code 43.Gross Weight(Kgs) 44. Net Weight(Kgs) 50. Quantity

2 3901.90.00.0000 1,000.0 (Kgs) 1,000.0 (Kgs) 1,000 (KGM)

39.Description of goods 40.Proceding Doc.

- Other polymers of ethylene, in primary forms- Other polymers of ethylene, in

primary forms

B. Guarantee 0.0 Type C. Office of Destination

Reference Date RUSUMO

D. Control By Office Of Departure E. Place & Date

Seals affixed Number 0 RUSUMO

Time Limit(Date) 12/12/2020 05/12/2020

Signature Signature REHEMA J MILLINGA(RMILLINGA)

Printed: 05/12/2020 15:41