‫ﺍ‬

‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‪123558170312 :‬‬ ‫ﺭﻗﻢ ﻣﺼﻠﺤﺔ ﺍﻟﺠﻤﺎﺭﻙ ﺑﻨﻈﺎﻡ ﺳﺪﺍﺩ‪030 :‬‬ ‫ﺟﻤﺮﻙ ﺍﻟﺒﻄﺤﺎﺀ ‪BAT‬‬ ‫ﺍﺳﻢ ﺍﻟﻤﻨﻔﺬ ‪:‬‬
‫‪ 4‬ﻧﻮﻉ ﺍﻟﻤﻨﻔﺬ ‪Port Type‬‬ ‫‪ 3‬ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ ‪Dec Type‬‬ ‫‪ 2‬ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ ‪Dec Date‬‬ ‫‪Dec No.‬‬ ‫‪ 1‬ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬
‫ﺑﺮﻱ‬ ‫ﺇﺣﺼﺎﺋﻲ ﻭﺍﺭﺩ‬ ‫‪1442-08-20‬‬ ‫‪64967‬‬ ‫ﺑﻴﺎﻥ ﺟﻤﺮﻛﻲ‬
‫‪Customs Declarat‬‬
‫‪2021-04-02‬‬
‫‪Net Weight‬‬ ‫‪ 7‬ﺍﻟﻮﺯﻥ ﺍﻟﺼﺎﻓﻲ‬ ‫‪Importer \ Exporter‬‬ ‫‪ 6‬ﺍﻟﻤﺴﺘﻮﺭﺩ ‪ /‬ﺍﻟﻤﺼﺪﺭ‬ ‫‪Delivery Order No.‬‬ ‫‪ 5‬ﺭﻗﻢ ﺇﺫﻥ ﺍﻟﺘﺴﻠﻴﻢ‬
‫ﻻﺳﺘﻌﻤﺎﻻﺕ ﻭﻛﻴﻞ ﺍﻟﻨﺎﻗﻠﺔ‬

‫ﻓﺮﻉ ﺷﺮﻛﺔ ﻛﺎﺕ ﺍﻧﺘﺮﻧﺎﺷﻨﺎﻝ ﻟﻴﻤﺘﺪ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺸﺤـﻦ‬

‫‪0.00‬‬
‫‪Intercessor Co.‬‬ ‫‪ 9‬ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﺳﻴﻄﺔ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺘﺄﻣﻴﻦ‬
‫ﻋﺪﺩ ﺍﻟﺸﺎﺣﻨﺎﺕ ‪1 :‬‬ ‫‪0.00‬‬
‫‪Gross Weight‬‬ ‫‪ 10‬ﺍﻟﻮﺯﻥ ﺍﻟﻘﺎﺋﻢ‬ ‫‪Carrier \ Captain \ Driver‬‬ ‫‪ 8‬ﺍﻟﻨﺎﻗﻠﺔ ‪ /‬ﺍﻟﻘﺒﻄﺎﻥ ‪ /‬ﺍﻟﺴﺎﺋﻖ‬
‫‪Commercial Reg. No.‬‬ ‫‪ 12‬ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬

‫‪Measurement‬‬ ‫‪ 13‬ﺍﻟﻘﻴﺎﺱ‬ ‫‪2052002989‬‬

‫‪s Name'Carrier‬‬ ‫‪ 11‬ﺍﺳﻢ ﺍﻟﻨﺎﻗﻠﺔ‬

‫‪Tin no‬‬ ‫‪ A 12‬ﺍﻟﺮﻗﻢ ﺍﻟﻀﺮﻳﺒﻲ‬

‫‪No. of Packages‬‬
‫‪Marks & Numbers‬‬
‫ﺍﻟﻤﺎﻟﻚ‬
‫‪s Agent Use"Carrier‬‬
‫‪ 16‬ﻋﺪﺩ ﺍﻟﻄﺮﻭﺩ‬ ‫‪3004502067‬‬ ‫‪Voyage \ Flight No.‬‬ ‫‪ 14‬ﺭﻗﻢ ﺍﻟﺮﺣﻠﺔ‬
‫‪0‬‬
‫‪Exported To‬‬ ‫‪ 15‬ﺍﻟﻤﺼﺪﺭ ﺇﻟﻴﻪ‬
‫‪ 19‬ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻷﺭﻗﺎﻡ‬ ‫‪L- AWB No. / Manif\B.‬‬ ‫‪ 17‬ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ ‪ /‬ﺍﻟﻤﻨﺎﻓﻴﺴﺖ‬
‫ﺭﻗﻢ ﺍﻟﺸﺎﺳﻴﻪ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬ ‫ﺍﻟﺴﺎﺋﻖ‬ ‫ﺑﺘﺎﺭﻳﺦ‬ ‫ﺍﻟﺤﺮﻛﺔ‬

‫‪Port of Loading‬‬ ‫‪ 18‬ﻣﻴﻨﺎﺀ ﺍﻟﺸﺤﻦ‬

‫‪ 233292A4DBA4XB2YV 25986‬ﺍﻟﺸﻤﻮﺥ ﻟﻠﻨﻘﻞ ﺑﺎﻟﺸﺎﺣﻨﺎﺕ ﺍ‬ ‫‪ 1442-08-19‬ﻣﺼﻄﻔﻰ ﺍﺑﺮﺍﻫﻴﻢ ﺍﻟﺤﺴﻴﻦ‬ ‫‪314010‬‬
‫‪6379027‬ﻣﺤﺮ ‪ 00878CAT0349DAJGB‬ﻓﺮﻉ ﺷﺮﻛﺔ ﻛﺎﺕ‬ ‫ﺍﻹﻣﺎﺭﺍﺕ‬
‫‪1442-08-19‬‬ ‫‪314012‬‬
‫‪Port of Discharge‬‬ ‫‪ 20‬ﻣﻴﻨﺎﺀ ﺍﻟﺘﻔﺮﻳﻎ‬
‫ﺟﻤﺮﻙ ﺍﻟﺒﻄﺤﺎﺀ ‪BAT‬‬
‫‪21 ÌåÉ ÇáãÞÕÏ‬‬ ‫‪Destination‬‬
‫ﺍﻟﺴﻌﻮﺩﻳﻪ‬
‫ﻣﻘﺎﺻﺔ‬
‫‪31‬‬ ‫‪30‬‬ ‫‪29‬‬ ‫‪28‬‬ ‫‪Currency‬‬ ‫ﺍﻟﻌﻤﻠﺔ‬ ‫‪25 24‬‬ ‫‪23‬‬ ‫‪22‬‬
‫ﺑﻨﻜﻲ‬ ‫ﺗﺤﺼﻴﻞ‬
‫ﻻﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﻤﺴﺘﻮﺭﺩ ﺃﻭ ﺍﻟﻤﺨﻠﺺ‬

‫ﺍﻹﻳﺮﺍﺩ‬ ‫ﻓﺌﺔ ﺍﻟﺮﺳﻢ ﻧﻮﻉ‬ ‫‪27‬‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻷﺟﻨﺒﻴﺔ ‪26‬‬ ‫ﻭﺻــﻒ ﺍﻟﺒــﻀــﺎﻋــﺔ‬ ‫ﺑﻨـﺪ ﺍﻟﺘﻌـﺮﻓـﺔ‬
‫ﺍﻟﺮﺳﻮﻡ‬ ‫ﺇﺟﻤﺎﻟﻲ‬
‫ﺇﻣﺎﺭﺍﺗﻲ(‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻟﻤﺤﻠﻴﺔ ‪)T IncomeD. Rate‬ﺩﺭﻫﻢ‬ ‫ﺍﻟﻨﻮﻉ‬ ‫‪Foreign‬‬ ‫ﺑﻠﺪ‬ ‫‪Goods Description‬‬ ‫‪T. Code.H‬‬

‫‪13727.00‬‬ ‫‪0‬‬ ‫‪%5‬‬ ‫‪280273.485‬‬ ‫‪1.02091‬‬ ‫‪AED 274533.00‬‬ ‫‪US‬‬ ‫‪ 870130000000‬ـ ﺟﺮﺍﺭﺍﺕ ﺑﺠﻨﺎﺯﻳﺮ‬ ‫‪Ã‬‬
‫ﺏ‬
‫ﺝ‬
‫ﺩ‬
‫ﻫـ‬
‫‪Weight‬‬ ‫ﺍﻟﻮﺯﻥ‬ ‫‪Item‬‬ ‫ﺍﻟﻄﺮﻭﺩﺑﻨﺪ ﺍﻟﺘﻌﺮﻓﺔ‪ Packages‬ﺍﻟﺼﻨﻒ‬
‫ﺑﻴﺎﻥ ﺍﻟﺪﺧﻮﻝ ‪Exemption of Duty‬‬ ‫ﺍﻻﻋﻔﺎﺀﺍﺕ‬ ‫‪37‬‬ ‫‪36‬‬ ‫‪35‬‬ ‫‪34‬‬ ‫‪33‬‬ ‫‪32‬‬ ‫ﺍﻟﻘﻴﻮﺩ ﺍﻟﺠﻤﺮﻛﻴﺔ ‪Customs Restrictions‬‬
‫‪ 44‬ﺍﻟﻤﺴﺘﻔﻴﺪ‬ ‫‪ 42‬ﺍﻟﺮﻣﺰ ‪ 43‬ﺍﻟﻤﺼﺪﺭ‬ ‫ﺍﻟﻘﺎﺋﻢ‬ ‫‪ÇáÜßÜãíÜÜÉ ÇáäæÚ‬‬ ‫ﺍﻟـﻜـﻤﻴــﺔ‬ ‫‪ 41‬ﻣﺮﺟﻊ ﺍﻟﻒ‬ ‫ﺍﻟﺠﻬﺔ‬ ‫‪40‬‬
‫ﺗﺎﺭﻳﺨﻪ‬ ‫ﺭﻗﻤﻪ‬ ‫ﺍﻟﺼﻨﻒ‬ ‫‪.Qty‬‬
‫‪Importer or Broker Use‬‬

‫‪Type‬‬

‫‪22-11-2020 000000000039724 1‬‬ ‫‪44500‬‬ ‫‪44500‬‬ ‫ﻭﺣﺪﺓ‬ ‫‪1.00‬‬ ‫ﺃ‬

‫ﺏ‬
‫ﺝ‬
‫ﺩ‬
‫ﻫـ‬

‫‪Duty‬‬ ‫ﺍﻟﺮﺳﻮﻡ‬ ‫‪Clearing Agent‬‬ ‫‪ 38‬ﺍﻟﻤﺨﻠﺺ ﺍﻟﺠﻤﺮﻛﻲ‬ ‫‪Inspection‬‬ ‫ﺍﻟﻤﻌﺎﻳﻨﺔ‬

‫ﻻﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﺠﻤﺎﺭﻙ‬

‫‪SR‬‬ ‫ﺭﻳﺎﻝ‬
‫ﺗﺤﺼﻴﻞ ﺑﺎﻟﺠﻤﺮﻙ‬ ‫‪Reasons For Not Releasing‬‬ ‫‪ 45‬ﺃﺳﺒﺎﺏ ﻋﺪﻡ ﺍﻟﻔﺴﺢ‬
‫‪ 56‬ﺍﻟﺮﺳﻮﻡ ﺍﻟﺠﻤﺮﻛﻴﺔ ‪Total Duty‬‬
‫‪3773.00‬‬ ‫ﻋﺒﺪﺍﻟﻠﻪ ﻣﺤﻤﺪ ﺟﻌﻤﻞ ﺍﻝ ﻛﻠﻴﺐ‬ ‫ﺍﻟﻤﺮﻓﻘﺎﺕ‬
‫‪0.00‬‬ ‫‪ A 56‬ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ‪VAT‬‬
‫‪Licence No.‬‬ ‫‪ 39‬ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬ ‫‪1442-08-19‬‬ ‫‪001‬‬ ‫ﺃﺧﺮﻯ‬
‫‪0.00‬‬ ‫‪Escise‬‬ ‫‪ B 56‬ﺍﻟﻀﺮﻳﺒﺔ ﺍﻻﻧﺘﻘﺎﺋﻴﺔ‬
‫‪418.00‬‬ ‫‪Handling‬‬ ‫‪ 57‬ﺭﺳﻮﻡ ﺍﻟﻤﻨﺎﻭﻟﺔ‬ ‫ﺭﺧﺼﺔ ﺗﺨﻠﻴﺺ ﺟﻤﺮﻛﻲ‬ ‫‪3256‬‬
‫‪Storage‬‬ ‫‪ 58‬ﺭﺳﻮﻡ ﺍﻷﺭﺿﻴﺎﺕ‬
‫‪0.00‬‬ ‫‪Transit‬‬ ‫ﺍﻟﺘﺮﺍﻧﺰﻳﺖ‬
‫‪120.00‬‬ ‫‪ 59‬ﺭﺳﻮﻡ ﺃﺧﺮﻯ ‪Other Charges‬‬
‫‪Route‬‬ ‫‪ 50‬ﺧﻂ ﺍﻟﺴﻴﺮ‬
‫‪Definite‬‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺮﺳﻮﻡ ‪ 60‬ﻗﻄﻌﻲ‬
‫‪4311.00‬‬ ‫‪Inspector‬‬ ‫‪ 46‬ﺍﻟﻤﻌﺎﻳﻦ‬
‫‪Insured‬‬ ‫‪ 61 TOTAL FEE‬ﺗﺄﻣﻴﻦ‬
‫‪0.00‬‬
‫‪Payment Method‬‬ ‫‪ 62‬ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬
‫ﺑﻨﻚ‬ ‫‪Exit Port‬‬ ‫‪ 51‬ﺟﻤﺮﻙ ﺍﻟﺨﺮﻭﺝ‬
‫‪Group Supervisor‬‬ ‫‪ 47‬ﺭﺋﻴﺲ ﺍﻟﻤﺠﻤﻮﻋﺔ‬
‫‪No.‬‬ ‫‪ 63‬ﺭﻗﻢ‬
‫‪Exit Transaction No.‬‬ ‫‪ 52‬ﻗﻴﺪ ﺍﻟﺨﺮﻭﺝ‬ ‫ﺫﻳﺐ ﻣﻨﺎﺣﻲ ﺍﻟﻌﺘﻴﺒﻲ‬
‫‪Other Remarks‬‬
‫‪Date‬‬ ‫‪ 64‬ﺗﺎﺭﻳﺦ‬ ‫ﻣﻼﺣﻈﺎﺕ ﺃﺧﺮﻯ ﺑﻴﺎﻥ ﺍﻟﺪﺧﻮﻝ‬ ‫‪48‬‬
‫‪Date‬‬ ‫‪ 53‬ﺗﺎﺭﻳﺨﻪ‬ ‫‪ÇáÅãÇÑÇÊ‬‬ ‫‪ÈíÇä ÌãÑßí‬‬
‫‪Bank‬‬ ‫‪ÇáÈäß ÇáÇåáì ÇáÊÌÇÑì‬‬ ‫‪ 65‬ﺑﻨﻚ‬ ‫‪Security Officer‬‬ ‫‪ 54‬ﻣﻮﻇﻒ ﺍﻷﻣﻦ‬
‫‪Customs Use‬‬

‫‪Receipt No.‬‬ ‫‪ 66‬ﺭﻗﻢ ﺇﻳﺼﺎﻝ ﺍﻟﺪﻓﻊ‬

‫‪90701‬‬
‫‪Date‬‬ ‫‪ 67‬ﺗﺎﺭﻳﺦ‬
‫‪22-08-1442‬‬ ‫‪Transit Inspector‬‬ ‫‪ 55‬ﻣﺮﺍﻗﺐ ﺍﻟﺘﺮﺍﻧﺰﻳﺖ‬ ‫‪Release Date‬‬ ‫‪ 49‬ﺗﺎﺭﻳﺦ ﺍﻟﻔﺴﺢ‬
‫‪bank‬‬ ‫‪ÝÑÚ ÇáÈØÍÇÁ‬‬ ‫‪ 68‬ﺑﻨﻚ‬
‫‪ÇáãÍÕá/ ãÓÊÎÏã ÇÝÊÑÇÖí áäÙÇã ÓÏÇÏ‬‬
‫ﻧﻤﻮﺫﺝ ‪/ 1‬ﺟﻤﺮﻛﻲ‬ ‫ﻃﺒﺎﻋﺔ ﺭﻗﻢ ‪2 :‬‬ ‫‪1 / 1‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻄﺒﺎﻋﺔ ‪08:121442-08-25 :‬‬