This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau

of Customs nor be relied upon as basis

for compliance with any legal requirement.
TEMPORARY SINGLE ADMINISTRATIVE DOCUMENT 1 DECLARATION Office Code: P07B
2 Exporter /Supplier Address Sub-Port of Mactan
7 7
HONGKONG YANGCHENG INTERNATIONAL INDUSTRIAL CO LTD Manifest No: BRA0269-23
FLAT RM 803 CHEVALIER HOUSE 45-51 CHATHAM ROAD SOUTH 3 Page Entry Number :
TSHIM SHA TSUI KL HONGKONG Date : 09/27/2023 09:06:10
1 5
1
5 Items 6 Tot Pack 7 Reference Number
1 9 DGQA2300719

8 Importer/Consignee, Address Tin: 219512788000 9 CRF No.

C MIESTO INTERNATIONAL FOODS CORP
J P RIZAL ST BASAK
U MANDAUE CITY
CEBU 10 11 12 Tot. F/I/O 13 T. Rel.
6014
S PHILIPPINES XX XX 609.36

14 Broker/Attorney-In-Fact, Address Tin: 288687704000 15 Country of Export 15 C.E. Code 17

T
ETHELYN CAUZON DELA CRUZ HONG KONG HK
1104 DONA VICTORIA BLDG429 UN
O COR LM GUERRERO ST BRGY 666 16 Country of Origin 17
ZONE 72
M ERMITA MANILA1000 HONG KONG
PHILIPPINES
S 18 Vessel/Aircraft Registry No. 19 Ct 20 Terms Of Delivery

BR281 BRA0269-23 0 FCA

21 Local Carrier (If Any) : 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thru Bank
USD 1,572.00 56.908 2

25 26 27 Transhipment Port 28 Financial and Banking Data Bank Code : 998

XX Terms of Payment : 01-Basic
1
29 Port Of Destination 30 Location Of Goods Bank Name : PCHC
P07B-Sub-Port of Mactan A11 Branch : NA Bank Ref No. : 011020011-3040290

Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code Rate Tariff Spec Spec Code
Marks & Nos : MIESTO INTERNATIONAL FOODS CORP
No. Of Packages : 1 39232990000 15.00 000000
9
Number and Kind : CT-CARTON
31 Packages Containers No(s) : 34 C.O. Code 35 Item Gross Wgt. 36 Pref
and Desc.
Of Goods
- - - Other HK 216.00 Kg(s)
Others
ENVELOPE JEJU POP 10X8X56ML BANANA MILK AND MELON
37 Procedure Item Net Weight 39 Quota

7100 000 212.00 Kg(s) NNNNN

40a AWB/BL 40b Previous Doc No.

695CAN43482574

44 Add Infos OTHInEV : 1 INSinFRT : 0 Fine : 0.00 41 Suppl. Units 42 Item Customs Value (F.C.) 43 V.M.
Doc / Produ.
Certif. & Aut. 1,572.00 NV
0.00
32,888.27 + 1,789.19 + 0.00 + 0.00 - 0.00
A.I. Code 45 Adjustment

Prev Doc Reference : 1.00

MSP 46 Dutiable Value (PHP)

Invoice No. : YC20230922 Dump Bond : 124,136.83

48 Prepaid Account No. 49 Identification of Warehouse

47 Calcula- Type Tax Base Rate Amount MP
tion of Taxes CBMW-0102 365
CUD 124,136.83 15% 18,620.53 1 47b ACCOUNTING DETAILS
.............................................................................................................................
VAT 148,587.36 12% 17,830.48 1 Mode Of Payment : CASH
Assessment Number : Date :
AVT 1
Receipt Number : Date :
EXC 0.00 1 Guarantee : 36,451.01 Date :
.............................................................................................................................
Total Fees 250.00
Total 36,451.01
Total Assessment 250.00
50 We hereby certify that the information contained in all pages of this Declaration and the documents submitted are Subscribed and sworn to before me
to the best of out knowledge and belief true and correct.

ETHELYN CAUZON DELA CRUZ MIESTO INTERNATIONAL FOODS CORP Administering Officer /
Notary Public
Broker Date : Importer/Attorney-In-Fact

51 AUTHORIZATION 52 Control at Office Destination

Date Print name Position Date Print name Position

This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

53 INTERNAL REVENUE (TAX PER BOX #46 & 47)

124,136.83 WHARFAGE 0.00 250.00
TAXABLE VALUE PHP OTHERS
0.00
BANK CHARGES 0.00 148,587.36
ARRASTRE CHARGES TOTAL LANDED COST PHP
18,620.53
CUSTOMS DUTY
5,300.00 DOCUMENTARY STAMP 280.00 17,830.48
BROKERAGE FEE TOTAL VAT PHP

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINED EXAMINATION RETURN 56 DATE RECEIVED 57 DATE RELEASED

ITEM
NO DESCRIPTION IN TARIFF TERMS SHOULD BE QTY UNIT UNIT VALUE TARIFF HEADING RATE

PLEASE REFER TO RIDER/S FOR FINDINGS ON ITHER ITEMS

REVISED CHARGES LIQUIDATION

59 CHARGES 60 DECLARATION 61 FINDINGS 62 DIFFERENCES 65 LIQUIDATION AMOUNT

PHP
DUTY

BIR Taxes
66 SHORT/EXCESS
VAT PHP
Excise Tax/Ad
Valorem 67 REMARKS

Others

Surcharges

TOTAL

63 ACTION DIRECTED / 64 68
RECOMMENDED
Date Date

69
Date Date

CONTINUATION FROM BOX # 31 FREE DISPOSAL

CUD 18,620.53
VAT 17,830.48
AVT 0.00

Total Items Taxes 36,451.01

SGL
IPF 250.00
IRS 30.00
CSF

Total Global Taxes 250.00

This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS

Terms Of Payment

Code Account
This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

Bank Reference Number : 011020011-3040290 Section : 12

Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
TEMPORARY ASSESSMENT NOTICE

Customs Office P07B Port of Sub-Port of Mactan

Identification of the Declaration

Ref Registration Assessment Nbr of

Year Number Date Year Number Day/Mth Items
Model

7 7 2023 09/27/23 2023 27/Septem 1

ber

Declarant Reference No : DGQA2300719

Declarant : 288687704000 ETHELYN CAUZON DELA CRUZ

1104 DONA VICTORIA BLDG429 UN
COR LM GUERRERO ST BRGY 666
ZONE 72
ERMITA MANILA1000
PHILIPPINES
Importer : 219512788000 MIESTO INTERNATIONAL FOODS CORP
J P RIZAL ST BASAK
MANDAUE CITY
CEBU
6014
PHILIPPINES

Mode of Payment : CASH Account Number

Receipt number and Statement number and date

date :

CUD 18,620.53
EXC 0.00
VAT 17,830.48
AVT 0.00

Total Items taxes 36,451.01

IPF
250.00
IRS 30.00

Total global taxes 250.00

Total assessed amount for the declaration

Amount currently to be paid 250.00

This temporary Assessment Notice provides advice to the declarant of the entry number assigned to the declaration
encoded. This document is of a temporary nature. The final Assessment Notice will be issued by BOC staff.