Shipper's Declaration Form (SDF)

Vessel Schedule Cut Off Cut Off Sailing ETA

Date: Carrier Vessel Voyage Date Time Date Destination Equipment To Use
Forwarding Company 20'
Origin 40'
Destination 40HC
Container Number 45'HC
Carrier MB/L Number
HB/L number
AMS House B/L number

1) Manufacturer Details (Last manufacture, assembles, produces, or grows the commodity. Or, supplier of the finished goods in the country from which the goods are leaving)
Name Address or DUNS# Tel Fax Email

AN CUONG HIGH - TECH BUILDING AN PHAT HIGH-TECHNOLOGY INDUSTRIAL PARK, KM47 NATION ROAD 5, VIET
MATERIALS JOINT STOCK COMPANY HOA WARD, HAI DUONG CITY, HAI DUONG PROVINCE, VIETNAM

2) Seller / Shipper Details (This element is consistent with the information required on the invoice of imported merchandise)
Name Address or DUNS# Tel Fax Email

AN PHAT INTERNATIONAL INC 10701 CORPORATE DR. STE. 268, STAFFORD, TX 77477

3) Buyer Details (Last known entity to whol the goods are sold or agreed to be sold)
Name Address or DUNS# Tel Fax Email

Woody&Lamy Floor INC 1122 SHOEMAKER AVE SANTA FE SPRINGS CA 90670 USA 562-777-9194

4) Ship To Party (First deliver-to party scheduled to physically receive the goods after the goods have been released from customs custody)
Name Address Tel Fax Email

Woody&Lamy Floor INC 1122 SHOEMAKER AVE SANTA FE SPRINGS CA 90670 USA 562-777-9194

5) Container Stuffing Location (The physical locations(s) where the goods were stuffed into the container)
Name Address Tel Fax Email

AN CUONG HIGH - TECH BUILDING AN PHAT HIGH-TECHNOLOGY INDUSTRIAL PARK, KM47 NATION ROAD 5, VIET
MATERIALS JOINT STOCK COMPANY HOA WARD, HAI DUONG CITY, HAI DUONG PROVINCE, VIETNAM

6) Consolidator or Stuffer (3rd party who stuffed the container or arranged for the stuffing of the container)
Name Address Tel Fax Email

AN CUONG HIGH - TECH BUILDING AN PHAT HIGH-TECHNOLOGY INDUSTRIAL PARK, KM47 NATION ROAD 5, VIET
MATERIALS JOINT STOCK COMPANY HOA WARD, HAI DUONG CITY, HAI DUONG PROVINCE, VIETNAM

7) Importer of record number (IRS, EIN, SSN or CBP assigned number of the entity liable for payment of all duties and meeting all regulatory requirements of importation)
46-1059080

8) Consignee Number
blank

9) Country Of Origin VIETNAM

10) Commodity Harmonized Tariff Schedule (HTS) Number

Shipper Booking Date PO # HTS Number Style No INV # Pieces Cartons CBM Weight Cargo Ready
SPC FLOOR
AN CUONG HIGH - TECH BUILDING HS CODE: 391810
MATERIALS JOINT STOCK COMPANY

VINYL MOLDING
HS CODE: 392590

Total 0 0 0.000 0.00 0

Hereby I/We declare that information given in this form is correct to the best of my knowledge and belief.

Form Filled By
Name

Designation Signature & Stamp

Company Name

* All items are important and are required to be filled by Shipper for ISF filings in USA prior than 24 hous of vessel sailing