SAD 500 - CUSTOMS DECLARATION FORM 1. DECLARATION A.

OFFICE OF DESTINATION OR DEPARTURE

0
2. EXPORTER / CONSIGNOR TIN OFF. CODE MANIFEST NUMBER
1
A 93271582346 VS 0449 17/12/2022
2 BSIC JSA
3 TRADEINN RETAIL SERVICES S.L 3.FORMS 4. REGISTRATION NUMBER & DATE ASSESSMENT NO & DATE
4 C PIRINEUS, 9
5
1 3 18/12/2022
6
CELRA
7
8. IMPORTER / CONSIGNEE TIN 70707070 5.ITEMS 6.TOT PACK 7.DECLARANT REF.NUMBER RECEIPT NO & DATE
8
9 BSIC 4 1 6742024704 / 300571055
NDUMISO LEBOGANG MAGAGANE
31 JUBANTONTO STREET 9 10 11 12.VALUE DETAILS 13 13A. INVOICE NO & DATE
3673
THUBELIHLE KRIEL 8901215357089 24044866 / 2022/12/15

14.DECLARANT /AGENT TIN 00426789 15.COE 16.COO 17.COD 17A.OWNER CODE 17B.REBATE USER CODE

DHL,INTERNATIONAL
ES ZA
CNR VANACHT & FABRIEK STREETS
DHL HOUSE, ISANDO, 1600

18.IDENTIFICATION, DATE AND NATIONALITY OF 19.CONTAINER 20.DELIVERY TERMS FOB

TRANSPORT AT ARRIVAL
22.CURRENCY AND TOTAL VALUE 23.RATE OF EXCHANGE
VS 0449 16/12/2022
2799
21.IDENTIFICATION, DATE AND NATIONALITY OF TRANSPORT AT 28.Consignt / Trans Particulars 24.OTHER COST DETAIL
FRONTIER
TRANS VALUE

2800 ZAR CURRENCY AMOUNT

25.TMF 26.TMI 27.PLACE OF DISCHARGE
FREIGHT
4 4
INSURANCE
29.OOE 30.LOCATION OF GOODS

B4 OTHER COST

MARKS 32.ITEM NO 33.COMMODITY CODE

31. ADDRESSED 1
PACKAGES AND 6105.10.00(4)
1
AND NUMBERS 34.COC 35.GROSS MASS(KGS) 36.PREFERENCE
DESC. OF NUMBERS & ES 0.94
GOODS TYPE OF ZERO ZERO ZERO ONE
37.CPC 38.NETT MASS(KGS) 39.QUOTA
PACKAGES
11/00
CONTAINER
NUMBERS 40.SUMMARY DECLARATION / PREV.DOCUMENT

DESCRIPTION G-STAR Pen Pocket Regular Shirt Dark Black S 6742024704

41.SUPP UNITS 42.CUSTOMS 43.V.M
1.00 NO VAL(FCY) N
0.00
0.00 959

44.ADD LICENSE NUMBER DEDUCTED VALUE DEDUCTED QUANTITY EX WAREHOUSE CODE 45.OTHER QUANTITIES
INFO NUIN
PRODUCE REMOVAL IN BOND(R.I.B) NO, DATE & OFFICE REBATE CODE 46.STATISTICAL VALUE
D DOCS.

47.CALC TYPE DUTY/TAX BASE RATE AMOUNT MP 48.ACCOUNT CODE 49.IDENTIFICATION OF WAREHOUSE/TIME LIMIT
OF DUTIES VAT 222.90 8XXXXX7270 D
& TAXES
SUMMARY OF TOTAL DUTIES AND TAXES
ATV 1,486.00
TOTAL DUTIES AND TAXES 1910.25
1P1 431.55
AMOUNT OVERPAID
AMOUNT UNDERPAID
OTHER
Total - First Item ( Excl ATV , VPB) 654.45 TOTAL PAYABLE
GUARANTEE Code Amount
DECLARATION FOR OFFICIAL USE
D R A F T
I. the undersigned of DHL INTERNATIONAL (PTY) LTD MRN :
( Customs Broker ) hereby declare that the particulars LRN :
herein are true and correct and comply with the provisions of the
B/E No :
Customs and Excise Act no.91 of 1964.
B/E Date :
Cust Inst :
2022/12/16

Signature I.D number Date Prepared By DHL

 SAD 501 - CUSTOMS DECLARATION FORM (Continuation sheet)
OFFICE 3. FORMS REGISTRATION NO 7. DECLARENT REFERENCE
1. IMPORTER OR EXPORTER TIN CODE AND DATE
2 3
31. MARKS 32.ITEM NO 33.COMMODITY CODE
ADDRESSED 1.00
PACKAGES AND 6105.10.00(4)
AND 2
NUMBERS 34.COC 35.GROSS MASS(KGS) 36.PREFERENCE
DESC. OF
GOODS NUMBERS ES 0.94
& TYPE OF One
37.CPC 38.NETT MASS(KGS) 39.QUOTA
PACKAGES
11/00
CONTAINER
NUMBERS 40.SUMMARY DECLARATION / PREV.DOCUMENT

DESCRIPTION DIESEL East O Long Sleeve Shirt Fiery Red S 6742024704

41.SUPP UNITS 42.CUSTOMS 43.V.M
3 VAL(FCY)
NO1.00
0.00
0.00 869

44.ADD LICENSE NUMBER DEDUCTED VALUE DEDUCTED QUANTITY EX WAREHOUSE CODE 45.OTHER QUANTITIES
INFO NUIN
PRODUCE REBATE CODE 46.STATISTICAL VALUE
REMOVAL IN BOND(R.I.B) NO, DATE & OFFICE
D DOCS.

31. MARKS 32.ITEM NO 33.COMMODITY CODE

ADDRESSED 1.00
PACKAGES AND 6105.10.00(4)
AND 3
NUMBERS 34.COC 35.GROSS MASS(KGS) 36.PREFERENCE
DESC. OF
GOODS NUMBERS ES 0.94
& TYPE OF One
37.CPC 38.NETT MASS(KGS) 39.QUOTA
PACKAGES
11/00
CONTAINER
NUMBERS 40.SUMMARY DECLARATION / PREV.DOCUMENT

DESCRIPTION REPLAY M6120D.000.22880 Short Sleeve T-Shirt Black S 6742024704

41.SUPP UNITS 42.CUSTOMS 43.V.M
3 VAL(FCY)
NO1.00
0.00
0.00 550

44.ADD LICENSE NUMBER DEDUCTED VALUE DEDUCTED QUANTITY EX WAREHOUSE CODE 45.OTHER QUANTITIES
INFO NUIN
PRODUCE REBATE CODE 46.STATISTICAL VALUE
REMOVAL IN BOND(R.I.B) NO, DATE & OFFICE
D DOCS.

31. MARKS 32.ITEM NO 33.COMMODITY CODE

ADDRESSED 1.00
PACKAGES AND 6105.10.00(4)
AND 4
NUMBERS 34.COC 35.GROSS MASS(KGS) 36.PREFERENCE
DESC. OF
GOODS NUMBERS ES 0.94
& TYPE OF One
37.CPC 38.NETT MASS(KGS) 39.QUOTA
PACKAGES
11/00
CONTAINER
NUMBERS 40.SUMMARY DECLARATION / PREV.DOCUMENT

DESCRIPTION REPLAY T-Shirt Black S 6742024704

41.SUPP UNITS 42.CUSTOMS 43.V.M
3 VAL(FCY)
NO1.00
0.00
0.00 421

44.ADD LICENSE NUMBER DEDUCTED VALUE DEDUCTED QUANTITY EX WAREHOUSE CODE 45.OTHER QUANTITIES
INFO NUIN
PRODUCE REBATE CODE 46.STATISTICAL VALUE
REMOVAL IN BOND(R.I.B) NO, DATE & OFFICE
D DOCS.

47. CALC TYPE DUTY/TAX BASE RATE AMOUNT MP TYPE DUTY/TAX BASE RATE AMOUNT MP
VAT 202.05 VAT 127.80
OF
ATV 1,347.00 ATV 852.00
DUTIES
1P1 391.05 1P1 247.50
& TAXES

Total - First Item ( Excl ATV , VPB) 593.10 Total - Second Item ( Excl ATV , VPB) 375.30

TYPE DUTY/TAX BASE RATE AMOUNT MP TYPE AMOUNT MP

VAT 97.95
ATV 653.00
1P1 189.45

Total - Third Item ( Excl ATV , VPB) 287.40 Grand Total (All Pages) 1,910.25
SAD 507 - ADDITIONAL INFORMATION / PRODUCED DOCUMENTS 51.OFFICE CODE 53.REGISTRATION NO AND DATE 54.DECLARANT REFERENCE
50.IMPORTER OR EXPORTER TIN 70707070 JSA
NDUMISO LEBOGANG MAGAGANE 6742024704
52.FORMS
31 JUBANTONTO STREET
3 3
THUBELIHLE KRIEL
GENERAL SEGMENT INFORMATION
House Waybill Numbers 19.Container (Cargo Status)

Documents Produced / Attached

6742024704

ITEM SEGMENT INFORMATION

40.Summary Declaration / Previous Document

Item Number Description / Particulars of Documents Item Number Description / Particulars of Documents Item Number Description / Particulars of Documents

31.Container Numbers 44.Additional Information

Item Item
Code Number / Amount Code Number / Amount
Number Number