ETHIOPIAN CUSTOMS

COMMISSION
DECLARATION FORM

1 DECLARATION A. CLEARANCE OFFICE AA KALITY (AAK)

2 Consignor/Exporter No Office Code Manifest Number
NEW SEBAT DISTICARE LTD. STI. MESIHPASA MH. SAITEFENDISK BINASHAN IM 4 AAK00
NO : 7/101 FATIH/ISTANBUL TEL :- 0212458 40 44
3 Forms 4 Loading Lists Registration number & date Assessment number & date
1 7
5 Items 6 Tot. Pkgs. 7 Declarant Reference number Receipt number & date
17 5852 2022 / AB008
8 Consignee/Importer No 0003697154 No 10 Country of Last
9 Person responsible for financial settlement
TADIWOS FANTAHUN FEKEDE TR Consign.
x
ADDIS ABABA 11 Trading

country
15 Country of dispatch/export 15 C. disp./exp. code 17 Country destin. code

Turkey a TR b a ET b AA
14 Declarant No 0019381377 16 Country of origin 17 Country of destination Section
ABEBAYEHU WORKU LIBEN (I) MANY Ethiopia EOG
RG: ADDIS ABABA ZN: ADDIS KETEMA
WR: NO WOREDA-140 KB :01/02/03 20. Delivery Terms Business Activity
FOB 02
18 Identity and nationality of means of transport at arrival 19 Ctr. 22 Currency and total amount invoiced 23 Exchange rate 24 Nature of
2022/T X USD 198.32 51.9654 transactio
21 Identity and nationality of active means of transport crossing the border 28 Financial and banking data 24 Invoice Details
Bank Code Currency Amount

25 Mode of transport 26 Inland mode 27 Place of Loading CBO COOPERATIVE BANK OF OROMIA Ex. Freight ETB 980,275.00

at the border of transport

Branch Terms of Payment Insurance ETB 405.00
62 3 Istanbul TRIST
CEN 1 BANK Other ETB 293,085.00
29 Office of entry/exit 30 Location of goods In. Freight ETB 119,438.00
B. P. number and date
GAL00 GALAFI (GAL) CBOCEN01014612021 14/10/2021 Total ETB 1,393,203.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 1 No 46021100 000 0000 0000
description
of goods BEAU6373159 HASU4717212 Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) HASU4898403 MRKU3255605
5852 PK Pack, Package a IT b 11.15
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of bamboo Ex. Freight 197.00 4081 000 9.99
BAMBOU IVORY 75PCS (CUTLERY SET) Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 59.00
In. Freight 24.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.04 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
004 005 006 007 008 081 031 032 033 118 013 001 034 46 Statistical Value
Proc. Program
282.00
Type Duty/Tax Base Rate Amount MP 48 Account No / Deferred Payment 49 Warehouse code / period
47 Taxes &
duties 01 282.00 25 70.50 1
03 353.00 0 0.00 1 Summary of Payables
04 353.00 15 52.95 1 Amount
05 405.00 10 40.50 1 Total duties & taxes 1,041,115.29
15 282.00 3 8.46 1 Guarantee amount 0.00
16 282.00 0.070000000000000 0.20 1 Total fees 0.00
Other 0.00
Total Payable 1,041,115.29
Total 172.61 1
50 Declaration C OFFICE OF DEPARTURE

I, Abebayehu Worku Liben (AG0963), the undersigned of ABEBAYEHU WORKU LIBEN (I) RG: ADDIS
ABABA ZN: ADDIS KETEMA WR: NO WOREDA-140 KB :01/02/03 do hereby declare that the information
and particulars declared are true and complete and accept fully the condition and requirements attaching to
the use of CPC declared here in and hold myself liable for any inaccurate information.

Signature Date & stamp Address

52 Guarantee Code 53 Office of destination (and country)

not valid for

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

Result:

Seals affixed: Number:

Signature and name of declarant/representative
Identity:
Abebayehu Worku Liben (AG0963)
Time limit (date):

Signature:
 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

2 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 2 No 39259000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 170.06
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Other Ex. Freight 3,015.00 4081 000 152.32
BLIND CURTAIN 175X200, Insurance 1.00
40 Summary declaration/Previous document / Way bill
180X200,198X200,200X200,215X200,267X250,272X200,305X250 Other Costs 901.00
In. Freight 367.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.61 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 4,316.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 3 No 73239300 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a IT b 103.15
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of stainless steel Ex. Freight 1,829.00 4081 000 92.39
Insurance 1.00 40 Summary declaration/Previous document / Way bill
CAKE FORK FLAS WHITE 6PCS,CAKE SERVER ARANNA IVORY 2PCS,CAKE
SERVER BAMBOU IVORY 2PCS,CULTERY SET ELENA IVORY 75PCS Other Costs 547.00
In. Freight 223.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.37 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 2,619.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 4 No 73239300 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a IN b 2.79
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of stainless steel Ex. Freight 49.00 4081 000 2.5
DECORATE PLATE 41X10X53 CM MODEL VI 061 Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 15.00
In. Freight 6.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.01 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 71.00
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 4,316.00 35 1,510.60 1 01 2,619.00 35 916.65 1
03 5,827.00 0 0.00 1 03 3,536.00 0 0.00 1
04 5,827.00 15 874.05 1 04 3,536.00 15 530.40 1
05 6,701.00 10 670.10 1 05 4,066.00 10 406.60 1
15 4,316.00 3 129.48 1 15 2,619.00 3 78.57 1
16 4,316.00 0.070000000000000 3.02 1 16 2,619.00 0.070000000000000 1.83 1

Total first item: 3,187.25 1 Total second item: 1,934.05 1

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 71.00 35 24.85 1 C OFFICE OF DEPARTURE
03 96.00 0 0.00 1
04 96.00 15 14.40 1
05 110.00 10 11.00 1
15 71.00 3 2.13 1
16 71.00 0.070000000000000 0.05 1

Total third item: 52.43 1 G.T.

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

3 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 5 No 94016900 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 13.94
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Other Ex. Freight 247.00 4081 000 12.5
FABRIC CHAIR Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 74.00
In. Freight 30.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value UNT 5 0.05 Code
Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 354.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 6 No 63031900 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 64.12
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of other textile materials Ex. Freight 1,136.00 4081 000 57.43
Insurance 0.00 40 Summary declaration/Previous document / Way bill
FABRIC CURTAIN 263X55,274X55
Other Costs 340.00
In. Freight 139.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.23 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 1,627.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 7 No 94016100 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 5.58
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Upholstered Ex. Freight 99.00 4081 000 4.99
FABRIC SOFA SET 8 SEAT WITH MDF 235X50 TV STAND AND MDF 128X78 Insurance 0.00
40 Summary declaration/Previous document / Way bill
,CENTER TABLE,FABRIC SOFA SET 8 SEAT WITH MDF CENTER TABLE Other Costs 29.00
In. Freight 12.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value UNT 2 0.02 Code
Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 141.00
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 354.00 35 123.90 1 01 1,627.00 35 569.45 1
03 478.00 0 0.00 1 03 2,196.00 8 175.68 1
04 478.00 15 71.70 1 04 2,372.00 15 355.80 1
05 550.00 10 55.00 1 05 2,728.00 10 272.80 1
15 354.00 3 10.62 1 15 1,627.00 3 48.81 1
16 354.00 0.070000000000000 0.25 1 16 1,627.00 0.070000000000000 1.14 1

Total first item: 261.47 1 Total second item: 1,423.68 1

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 141.00 35 49.35 1 C OFFICE OF DEPARTURE
03 190.00 0 0.00 1
04 190.00 15 28.50 1
05 219.00 10 21.90 1
15 141.00 3 4.23 1
16 141.00 0.070000000000000 0.10 1

Total third item: 104.08 1 G.T.

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

4 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 8 No 70132200 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 30407.83
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of lead crystal Ex. Freight 539,121.00 4081 000 27234.5
GLASS ALL PURPOSE (NEV 574F) 355CC,12 OZ,GLASS BEER (BR029F) Insurance 223.00
40 Summary declaration/Previous document / Way bill
565CC,19 1/4 OZ,GLASS BEER (SRG375F) 380CC, 12 3/4 OZ,GLASS BOTTLE Other Costs 161,187.00
(SUT101PK222Z1) 1020 CC,34 1/2 OZ,GLASS BOWL (ALN260F) 345CC,11 3/4
In. Freight 65,687.00
OZ, (ALN290R6) 2050 CC, 69 1/4 OZ,(ART267F) 330CC,11 41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 109.07 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 771,886.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 9 No 94035000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 13.94
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Wooden furniture of a kind used in the bedroom Ex. Freight 247.00 4081 000 12.48
Insurance 0.00 40 Summary declaration/Previous document / Way bill
MDF BED SET 180X200 CM WITH 2 COMODINO AND 120X46 CM DRESSING
TABLE,MDF COFFEE TABLE,MDF COFFEE TABLET SET,MDF DINNING TABLE Other Costs 74.00
SET WITH 6 CHAIR,MDF DINNING TABLE WITH 8 CHAIRS AND 225X50 CM In. Freight 30.00
CONSOL SET 41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value UNT 5 0.05 Code
Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 354.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 10 No 61071100 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 1343.78
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of cotton Ex. Freight 23,825.00 4081 000 1203.54
MEN BOXER Insurance 10.00
40 Summary declaration/Previous document / Way bill
Other Costs 7,123.00
In. Freight 2,903.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value UNT 482 4.82 Code
Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 34,111.00
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 771,886.00 35 270,160.10 1 01 354.00 35 123.90 1
03 1,042,046.00 0 0.00 1 03 478.00 0 0.00 1
04 1,042,046.00 15 156,306.90 1 04 478.00 15 71.70 1
05 1,198,353.00 10 119,835.30 1 05 550.00 10 55.00 1
15 771,886.00 3 23,156.58 1 15 354.00 3 10.62 1
16 771,886.00 0.070000000000000 540.32 1 16 354.00 0.070000000000000 0.25 1

Total first item: 569,999.20 1 Total second item: 261.47 1

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 34,111.00 35 11,938.85 1 C OFFICE OF DEPARTURE
03 46,050.00 8 3,684.00 1
04 49,734.00 15 7,460.10 1
05 57,194.00 10 5,719.40 1
15 34,111.00 3 1,023.33 1
16 34,111.00 0.070000000000000 23.88 1

Total third item: 29,849.56 1 G.T.

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

5 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 11 No 83024900 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 8.36
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Other Ex. Freight 148.00 4081 000 7.49
METAL CURTAIN RAIL 214 CM,238CM Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 44.00
In. Freight 18.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.03 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 212.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 12 No 73239300 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a IN b 2.79
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of stainless steel Ex. Freight 49.00 4081 000 2.5
Insurance 0.00 40 Summary declaration/Previous document / Way bill
METAL SAUCER 6PCS PLATE MODEL :LYSN 083
Other Costs 15.00
In. Freight 6.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.01 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 71.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 13 No 84162000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 5.58
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Other furnace burners, including combination burners Ex. Freight 99.00 4081 000 4.99
OUT DOOR PYRAMID GAS HEATER Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 29.00
In. Freight 12.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.02 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 141.00
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 212.00 15 31.80 1 01 71.00 35 24.85 1
03 244.00 0 0.00 1 03 96.00 0 0.00 1
04 244.00 15 36.60 1 04 96.00 15 14.40 1
05 280.00 0 0.00 1 05 110.00 10 11.00 1
15 212.00 3 6.36 1 15 71.00 3 2.13 1
16 212.00 0.070000000000000 0.15 1 16 71.00 0.070000000000000 0.05 1

Total first item: 74.91 1 Total second item: 52.43 1

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 141.00 5 7.05 1 C OFFICE OF DEPARTURE
03 148.00 0 0.00 1
04 148.00 15 22.20 1
05 170.00 0 0.00 1
15 141.00 3 4.23 1
16 141.00 0.070000000000000 0.10 1

Total third item: 33.58 1 G.T.

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

6 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 14 No 39249000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a TR b 23100.69
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Other Ex. Freight 409,568.00 4081 000 20689.94
PLASTIC 05005 LAUNDARY BASKET LEAD,PLASTIC 1.2 LT FLAT RECTANGLE Insurance 169.00
40 Summary declaration/Previous document / Way bill
MULTI BOX MODEL NO :02-1111,PLASTIC 1.2 LT MAGIC FOLDABLE MUG Other Costs 122,453.00
MODEL NO :08-1213,PLASTIC 10 LT EASY DUSTBIN,PLASTIC 10LT
In. Freight 49,902.00
FANTASYDUSTBIN,PLASTIC 10LT FLAT RECTANGLE MULTI 41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 82.86 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 586,398.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 15 No 69111000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a CN b 16.72
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Tableware, and kitchenware Ex. Freight 296.00 4081 000 14.98
Insurance 0.00 40 Summary declaration/Previous document / Way bill
PORCELAIN COFFEE CUP SET MODEL :LYBA 003,PORCELAIN COFFEE CUP
SET MODEL :LYBA 007,PORCELAIN COFFEE CUP SET MODEL : LYYK Other Costs 88.00
023,PORCELINE DINNER SET 24PCS MODEL :LYEP 002 In. Freight 36.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.06 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 423.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 16 No 69111000 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a EG b 5.58
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
- Tableware, and kitchenware Ex. Freight 99.00 4081 000 4.98
PORCELAIN DINNER SET 58PCS MODEL :LYEP 002 Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 29.00
In. Freight 12.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.02 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 141.00
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 586,398.00 35 205,239.30 1 01 423.00 35 148.05 1
03 791,637.00 0 0.00 1 03 571.00 0 0.00 1
04 791,637.00 15 118,745.60 1 04 571.00 15 85.65 1
05 910,383.00 10 91,038.30 1 05 657.00 10 65.70 1
15 586,398.00 3 17,591.94 1 15 423.00 3 12.69 1
16 586,398.00 0.070000000000000 410.48 1 16 423.00 0.070000000000000 0.30 1

Total first item: 433,025.62 1 Total second item: 312.39 1

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 141.00 35 49.35 1 C OFFICE OF DEPARTURE
03 190.00 0 0.00 1
04 190.00 15 28.50 1
05 219.00 10 21.90 1
15 141.00 3 4.23 1
16 141.00 0.070000000000000 0.10 1

Total third item: 104.08 1 G.T.

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - Continuation sheet

1 DECLARATION A. CLEARANCE OFFICE

8 Consignee/Importer No 0003697154 Office Manifest Number
TADIWOS FANTAHUN FEKEDE IM 4
AAK00
x
ADDIS ABABA 3 Forms Registration number & date Assessment number & date

7 7
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 17 No 70132200 000 0000 0000
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 0 PP Part pakage a CZ b 13.94
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
-- Of lead crystal Ex. Freight 250.00 4081 000 12.48
WATER GLASS SET 440ML,MODEL :LYRS 148,WINE GLASS SET 260ML Insurance 0.00
40 Summary declaration/Previous document / Way bill
MODEL :LYEM 002,WINE GLASS SET 330 ML MODEL :LYRS 147 Other Costs 78.00
In. Freight 30.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value 0.05 Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
Proc. Program 46 Statistical Value
Model 361.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers No
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) a b
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
Ex. Freight
Insurance 40 Summary declaration/Previous document / Way bill
Other Costs
In. Freight
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes
Proc. Program 46 Statistical Value
Model
31 Packages Marks & 32 Item 33 Commodity Code
and numbers No
description
of goods Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) a b
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
Ex. Freight
Insurance
40 Summary declaration/Previous document / Way bill
Other Costs
In. Freight
41 Supplementary units 42 Item price 43 V.M.

44 Additional License number Deducted Quantity Deducted Value Code

Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes
Proc. Program 46 Statistical Value
Model
Type Duty/Tax Base Rate Amount M Type Duty/Tax Base Rate Amount MP
47 Taxes &
duties 01 361.00 35 126.35 1
03 487.00 0 0.00 1
04 487.00 15 73.05 1
05 560.00 10 56.00 1
15 361.00 3 10.83 1
16 361.00 0.070000000000000 0.25 1

Total first item: 266.48 1 Total second item:

Type Duty/Tax Base Rate Amount M Type Amount M ← SUMMARY
01 491,114.90 1 C OFFICE OF DEPARTURE
03 3,859.68 1
04 284,772.50 1
05 218,280.50 1
15 42,105.24 1
16 982.47 1

Total third item: G.T. 1,041,115.29 1

 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - List of Containers

1 DECLARATION A. CLEARANCE OFFICE

Office Manifest Number
IM 4
AAK00

3 Forms 5 Items Registration number & date Assessment number & date

7 17

# Container Reference Item No Type E/F Other characteristics

1 BEAU6373159 1 45GP 1/1 TR4281057

2 HASU4717212 1 45GP 1/1 TR4281125

3 HASU4898403 1 45GP 1/1 TR4489349

4 MRKU3255605 1 45GP 1/1 TR4489254

5 MRKU5121483 1 45GP 1/1 TR4281053

6 TCNU2976105 1 45GP 1/1 TR4281123