Disclaimer: This document is for information purposes only and shall NOT be submitted or used for processing at the

Bureau of Customs nor be relied

upon as a basis for compliance with any legal requirement.
TEMPORARY SINGLE ADMINISTRATIVE DOCUMENT

1 DECLARATION Office Code P02B

2 Exporter / Supplier Address Manila Intl Container Port
4ES 4
1 SHANGHAI NEWSUN INTERNATIONAL
TRADING CO., LTD721, NO. 1509, 3 Page 4
Customs Reference

CAOAN ROAD, SHANGHAI, CHINA 1 1 Registry Number CCL0039-20

C 5 Items
1
6 Tot Pack
10800
7 Reference Number
A2130112403
8 Importer / Consignee, Address TIN: 215261911000 9 CRF NUMBER :
U ARVIN INTERNATIONAL MARKETING INC.
PUROK 3 BRGY. GAHONON, DAET T/S or W/S Entry No. :

CAMARINES NORTE 4600

S PHILIPPINES 10 11 12 Tot. F/I/O (Php)
142,758.99
13 T. Ref.

14 Broker / Attorney-In-Fact, Address TIN: 501869203000 15 Country of Export 15 C.E. Code 17

T ANNETTE PATRICE BALABA BORMATE
2337 LEVERIZA ST BRGY 32 PASAY CITY
CHINA CN PH

1300 16 Country of Origin 17 Country of Destination

PASAY CITY 1300
O PHILIPPINES CHINA PHILIPPINES
18 Vessel / Aircraft 19 Ct 20 Terms of Delivery
JINGHUAI 9 HAO 509E CCL0039-20 FOB
M 21 Local Carrier (if any) 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thru Bank
USD 13,500.00 48.067 2 X
S 25
12/17/2020
26 27 Transhipment Port
28 Financial and Banking Data - Bank Code 998
Terms of Payment 01 - Basic
29 Port of Destination 30 Location of Goods
1 P02B
Manila Int'l Container Port S03
Bank Name

Branch
PCHC
NA Bank Ref Number: 010533457-0005460

31 Packages Marks and Numbers - Container No(s) 32 Item No. 33 HS Code Spec Code
and 1 25010050 000
Marks & No 10X20 STC: SEA DRAGON SALT
Description of Packages 34 C.O. Code 35 Item Gross Weight (kg) 36 Pref
of Goods
Number and Kind 10800 BG BAG CN 270,540.00 ACFTA
Container No(s) CSNU1847730 TLLU2899139 TLLU3101285 TLLU2886152 37 Procedure 38 Item Net Weight (kg) 39 Qouta
- Sea water
4000 N55 270,000.00 NNNNN
10X20 STC: SEA DRAGON NON-IODIZED SALT 40a AWB / BL 40b Previous Doc No.
COAU7227799480
41 Suppl. Units 42 Item Customs Value (F. Cur) 43 V.M.

13,500.00 NV
44 Add Infos OTHinEV : 1 INSinFRT : 0 Fine :
Doc / Product A.I. Code 45 Adjustment
Certif. & 129,780.90 + 12,978.09 + 0.00 + 5,193.50 - 37,270.00
Aut 1.00
A.D.

46 Dutiable Value (PHP)

791,663.49
Invoice No. : INAR2011J Dump Bond :

47 Calculation Type Tax Base Rate Amount MP 48 Prepaid Account No. 49 Identification of Warehouse
of Taxes
/
CUD 791,663.49 0% 0.00 0
47b ACCOUNTING DETAILS
VAT 841,431.57 12 % 100,971.79 0
Method of Payment : CASH
Assessment Number : Date :

Reciept Number : Date :

Guarantee 0.00 Date :

Total Fees 0.00

Total Item: 100,971.79 Total Assessment 0.00

50 We hereby certify that the information contained in all pages Subscribed and sworn bofore me
of this Declaration and the documents submitted are to the best
of our knowledge and belief true and correct

51 AUTHO- Broker : Date : Importer / Attorney-in-Fact :

RIZATION Administering Officer
ANNETTE PATRICE BALABA BORMATE ARVIN INTERNATIONAL MARKETING INC. Notary Public

52 Control Code 53 Office of Destination and Country

at Office Destination
CONTROL AT OFFICE OF DESTINATION Stamp 54 Place and date

Signature
Disclaimer: This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as a basis for compliance with any legal requirement.
TEMPORARY SINGLE ADMINISTRATIVE DOCUMENT

53 INTERNAL REVENUE (TAX PER BOX #45 & #47)

TAXABLE VALUE PH 791,663.49 WHARFAGE 5,193.50 OTHERS 1,000.00

BANK CHARGES 0.00 TOTAL 841,446.57

ARRASTRE CHARGE 37,270.00
CUSTOMS DUTY 0.00 LANDED COST PH x 12%

BROKERAGE FEE 6,039.58 DOCUMENTARY STAMP 280.00 TOTAL VAT PH 100,973.59

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINED 56 DATE RECIEVED 57 DATE RELEASED

EXAMINATION RETURN

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

PLEASE REFER TO RIDERS FOR FINDINGS ON OTHER ITEMS

REVISED CHARGES LIQUIDATION

59 CHARGES 60 DECLARATION 61 FINDINGS 62 DIFFERENCES 65 LIQUIDATED Amount

Duty
BIR Taxes 66 SHORT/EXCESS
VAT
Excise Tax/Ad Valorem 67 REMARKS
Others
Surcharges
TOTAL
63 ACTION DIRECTED/RECOMMENDED 64 68

DATE COO III DATE

69

DATE COO V DATE

CONTINUATION FROM BOX # 31 FREE DISPOSAL CUD 0.00

Container Numbers continuation: VAT 100,973.59
CSNU1361902 AVT 0.00
TLLU2601882
OOLU1437749 Total Item Tax 100,973.59
TLLU3096825 IPF 1,000.00
UETU2299443
DFSU2968920

CDS 250.00
IRS 30.00
Total Global Tax 1,280.00
102,253.59