UNCTAD/ASYCUDAWorld A OFFICE OF

1 DECLARATION
KTM
2 Exporter No. IM 4 KATIMA MULILO
ADRIAN BERISHA Customs Reference
11UPWELL ROAD 3 Forms 4 Load C 1200 09/02/2022
DUBLIN
1 1 Manifest
IRELAND
5 Items 6 Nbr packages 7 Reference number

1 1 2022 SMK007

8 Consignee No. 1005481720 9 Financial No.

ROSEMARY MUTALE CHIPELEME 1

F377A/5B FLAT 11
KABULONGA ROAD
Lusaka
10 Cty f. dest 11 Trading 12 Value details 13 C.A.P.
Lusaka Province
of IE cty. 30,477.00
14 Declarant No. 1003764975 15 Country of export 15 C.E. 17 C.D. Code

TWANGE FREIGHT LIMITED IRELAND a IE b a ZM b

PLOT NO.2675 16 Country of origin 17 Country of destination
KALIMBA FARM ROAD
IRELAND ZAMBIA
18 Identity and nationality of means of transport at arrival / at 19 20 Delivery terms

no CIF KTM
21 Identity and nationality of active means of transport crossing the 22 Currency & total amount 23 Exch. rate 24 Nature of

OWNWEELS NA GBP 4,000.00 24.1887 1 transac.

25 Mode 26 Inland mode 27 Place of loading/unloading 28 Financial and banking data Bank
62 at border Transport Terms of 1 Cash
29 Office of entry/exit 30 Location of goods
KTM KATIMA MULILO KTMCUSTOMS
31 Packages Marks and numbers - Containers No(s) - Number and kind 32 Item 33 Commodity code
and
Marks & no ADD 1 No 87033390 080
descriptio
of goods CHASSIS# 1J8GME8587W533715 34 Cty. orig. 35 Gross mass (kg) 36 Prefer.
of

Number and 1 NE a IE b 2,520.00

Kind UNPACKED OR UNPACKAGED 37 PROCEDURE 38 Net mass (kg) 39 Quota

Containers No
4000 000 2,520.00
40 Summary declaration / Previous document S/L
Vehicles with only diesel... engine of cc >2500cc =<3000cc - OTHER
USED JEEP CHEROKEE 41 Supplementary units 42 Item Price 43 V.M.

44 Add. info Licence No V 317 D.Val D.Qty 2007 11 1.00 4,000.00 cod
Document
Produced
20,560.40+0.00+1,451.32+8,466.04-0 A.I. Code 45 Adjustment

Certificate A.D. 025 002 1.0000

and autho- Vin Number 46 Statistical value
rization
127,232.56
47 Calcul- Type Tax base Rate Amount M 48 Deferred payment 49 Identification of warehouse
ation of
taxes MVF 1.00 483.000 483.00 1
CES 2,776.00 240.000 240.00 1 B ACCOUNTING DETAILS
CD 51,739.69 15,521.910 15,521.91 1 CASH
Mode of payment
MVS 1.00 2,000.000 2,000.00 1
Assessment number A 2211 / Date 09/02/2022
EDI 67,261.60 20,178.480 20,178.48 1
Receipt number Date
VAT 87,440.08 13,990.410 13,990.41 1
Guarantee 0.00 ZM Date

Total fees 500.10 ZM Total MP3

Total 52,413.80 1 Total 52,913.90 ZM 0.00

50 Principal No. Signatur C OFFICE OF DEPARTURE

51 Intended Represented by
offices of Place and date
transit
country

52 Code 53 Office of destination and country

not valid

D CONTROL BY OFFICE OF DESTINATION Stamp: 54 Place and date

Declarant name/representative
Signatur