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Marine Cargo Insurance

(AMENDED)

TIN 0083260438 App. Ref. No. 0083260438/24/22

License No. MT/AA/14/673/4681046/2016 (BL) Reference Date 18/01/2024

Name DELTA ELECTRON TRADING PLC Previous Policy No.

App. No. LISC/24/273


Address ADDIS ABABA BOLE NO WOREDA-144 WOREDA 03, 2483/M02
LPCO Ref. No. LISC/24/273/MC1

Policy No. P/100/3001/2023/00476 Policy Date 18/01/2024

Valid Until 17/04/2024

Means of Voyage Sea transport

Bank Hibret Bank Branch United Bank Head Office

Insurer LION INSURANCE COMPANY (S.C) Branch MAIN

Voyage From Qingdao Pt(CNQDG) Voyage To Modjo(ETMOJ)

Insured Remark

Delta Electron Trading PLC & United Bank S.C Head Office Port of Loading : Qingdao Port to Port of Destination: Modjo

Invoice Type Proforma Invoice No. Q24010400B

Invoice Date 04/01/2024 Total Count of Items 4

Total Invoice Amount [USD] 5,000 Equivalent in Birr [56.213] 281,065

Contingency Price(Birr) [10%] 28,106.5 Other(birr) 0

Sum Insured 309,171.5 Terms of Delivery Free on board

Cost [USD] 5,000 Freight

Other [USD] 0 Insurance

Commodity

Invoice Number of
No HS Code Invoice Amount Quantity Unit Price Net Weight Gross Weight Country of Origin
Amount(Birr) Packages

40111000 [USD] 3,285 [CT] 1,800 [USD] 1.825 184,659.7049 China

NEW PNEUMATIC TYRES, Of RUBBER OF A KIND USED ON MOTOR CARS(INCLUDING STATION WAGONS...
1
KINGSTON TIRE TUBE THREE HUNDRED BY SEVENTEEN

40111000 [USD] 584 [CT] 320 [USD] 1.825 32,828.392 China

NEW PNEUMATIC TYRES, Of RUBBER OF A KIND USED ON MOTOR CARS(INCLUDING STATION WAGONS...
2
KINGSTON TIRE TUBE THREE HUNDRED BY EIGHTEEN

40111000 [USD] 1,000 [UNT] 500 [USD] 2 56,213 India

NEW PNEUMATIC TYRES, Of RUBBER OF A KIND USED ON MOTOR CARS(INCLUDING STATION WAGONS...
3
TIRE TWO POINT SEVENTY-FIVE BY SEVENTEEN

44140000 [USD] 131 [NPR] 4 [USD] 32.75 7,363.903 China

Wooden frames for paintings, photographs, mirrors or similar objects.


4
RAV4 SIDE MIRROR LEFT AND RIGIT

Approver Name Date LPCO ID


Elsa Awel 18/01/2024 f4b4459491

Page 1 of 1 Ethiopia Electronic Single Window


P.O Box 2559, Addis Ababa, Ethiopia
Visit http://esw.et/esw-cbra/ for online verification
Information => LPCO outsider => LPCO ID

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