EUROPEAN UNION 1 DECLARATION TYPE LRN: DE732154452123FG0QS41

S32 Other SCI

2 Consignor / Exporter No T1
PJSC "DNEPROMETIZ"
PL302060 DOROHUSK OC DROGOWY
SLOBOZHANSKYI AV.20 49000 3 Forms S00 Sec.
DNIPRO / UKRAINE Deci.
001 S
TRANSIT/SECURITY ACCOMPANYING DOCUMENT

5 Items 6 Total Packages 35 Gross mass (kg)

1 19 22.325.0

8 Consignee No 7 Reference numbers

BETOTRADE OU EUK230003173

RAUDTEE 12 0000 Return copy has to be sent to the office:

TARTU / ESTONIA

S12 Date and time of arrival at first place of arrival in Customs teritory 15 C.disp./exp .Code 17 Country destin. Code
UA EE

S29 Transport charges method of payment 56 Other incidents during carriage

D Details and measures taken G Other incidents during carriage
18 Identity and nationality of means of transport at departure
AE2602MC / AE2517XG UA

21 Identity and nationality of means of transport crossing the border

AE2602MC / AE2517XG UA

25 Mode of transport 30 Location of goods

30 at the board

S17 Place of loading S18 Place of unloading S13 Countr(ies) of routing codes
UA EE UA,PL,LT,LV,EE

S10 Conveyance reference number

S06 Consignee (security) No S04 Consignor (security) No

BETOTRADE OU PJSC "DNEPROMETIZ"
RAUDTEE 12 0000 SLOBOZHANSKYI AV.20 49000
TARTU / ESTONIA DNIPRO / UKRAINE

S07 Carrier (security) No S28 Seal Number

LTD UTA TRUCK SERVICE
AVE.BOHDAN KHMELNYTSKYI 132/10 49033
DNIPRO / UKRAINE

55 Place and country: Place and country:

Transhipments
Ident. and nat. new means transp.: Ident. and nat. new means transp.:

Ctr. (1) Identity of new container: Ctr. (1) Identity of new container:

(1) Enter 1 if YES and 0 if NO. (1) Enter 1 if YES and 0 if NO.

F CERTIFI New seals Number identity: New seals Number identity:

CATION BY
COMPE TENT Signature Stamp: Signature Stamp:
AU-
THORITIES

Data already recorded into the system Data already recorded into the system

50 Principla/TIR Holder C OFFICE OF DEPARTURE

ZOLLMAX TRANSİT LOGİSTİK GMBH. PL302060 (DOROHUSK OC DROGOWY)
Goethestr. 7 40237 2023-07-11 00:00:00 +0300
DUSSELDORF / GERMANY

51 Intended
offices of
transit (and
country)

3- 21DE0000000081910 Code 53 Office of destination (and country)

52 Guarantee
not vaild for EE1310EE Lennujaama tollipunkt

D CONTROL BY OFFICE OF DEPARTURE I CONTROL BY OFFICE OF DESTINATION

Result: Date of arrival: Return copy sent

Seals affixed: Number: Examination of seals: on
identity: after registration under
Time limit (date): Remarks: No:
Signature: Stamp:
 TRANSIT/SECURITY LIST OF ITEMS

32 Item No 31/1 Number and kind of packages, markes and numbers of packages 31/2 Description

2 Consignor/Exporter 8 Consignee

S04 Consignor (security) S06 Consignee (security)

40 Summary declaration/Previous document

41/1 Produced documents / certificates
44/2 Special mentions

18 Identity and nationality of means of transport at departure 7 Unique consignment reference number

21 Identity and nationality of active means of transport crossing the border 31/3 Container numbers S28 Seal Number

S18 Place of unloading 33 Commodity Code 35 Gross mass (kg)

44/4 UNDG S29 Tpt.Ch.M.Pay.code 1 Declaration Type 15 C.disp/exp.Code 17 C.Dest.Code 38 Net mass (kg)

1 ADDR - 19 PX włókna stalowe do zastosowań konstrukcyjnych w zaprawach betonowych i zaczynach o nominalnej

wielkości 75/52
PJSC "DNEPROMETIZ" BETOTRADE OU
SLOBOZHANSKYI AV.20 49000 DNIPRO/UKRAINE RAUDTEE 12 0000 TARTU/ESTONIA

730-CMR (Siuntinio kelio pastaba); 555476, 380 komercinė sąskaita; 1,

AE2602MC / AE2517XG

AE2602MC / AE2517XG

EE 73262000 22,325.00

T1 21,375.00