UNCTAD/ASYCUDAWorld A OFFICE OF

1 DECLARATION
KTM
2 Exporter No. IM 4 KATIMA MULILO
SANDRA MUBIANA Customs Reference
9 FIRSBY ROAD QUINTON 3 Forms 4 Load C 7 02/01/2022
BIRMINGHAM
1 1 Manifest
5 Items 6 Nbr packages 7 Reference number

1 1 2022 GBY

8 Consignee No. 2221577479 9 Financial No.

Irene Mwezi 1
7007 Burma Road
Burma Road
Lusaka
10 Cty f. dest 11 Trading 12 Value details 13 C.A.P.
Lusaka Province
of GB cty. 27,925.00
14 Declarant No. 1019797546 15 Country of export 15 C.E. 17 C.D. Code

TOPRATE CARGO LIMITED UNITED KINGDOM a GB b a ZM b

OFF SESHEKE SENANGA ROAD 16 Country of origin 17 Country of destination
SESHEKE
UNITED KINGDOM 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

O/W NA GBP 1,500.00 22.4846 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 CHASIS# SALLNABA74A427155 1 No 87032390 060
descriptio
of goods ENG# TBA 34 Cty. orig. 35 Gross mass (kg) 36 Prefer.
of

Number and 1 NE a GB b 1,800.00

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

Containers No
4000 403 1,800.00
40 Summary declaration / Previous document S/L
Vehicles with only engine of cc >1500cc but =< 2500cc - OTHER >5yrs
USED LANDROVER FREELANDER 41 Supplementary units 42 Item Price 43 V.M.

44 Add. info Licence No V2 D.Val 1,500.00 D.Qty 2004 11 1.00 1,500.00 cod
Document
Produced
18,662.22+0.00+1,394.05+7,869.61-0 A.I. Code 45 Adjustment

Certificate A.D. 025 002 1.0000

and autho- Vin Number 46 Statistical value
rization
61,652.78
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 2,000.00 168.000 168.00 1 B ACCOUNTING DETAILS
CD 61,652.78 0.000 0.00 1 CASH
Mode of payment
MVS 1.00 2,000.000 2,000.00 1
Assessment number A 15 / Date 02/01/2022
EDI 39,104.47 0.000 0.00 1
Receipt number Date
VAT 50,836.15 0.000 0.00 1
Guarantee 0.00 ZM Date

Total fees 500.10 ZM Total MP3

Total 2,651.00 1 Total 3,151.10 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