OFFICE OF DISPATCH/ EXPORT

Export Single Administrative Document

1 DECLARATION Office code : P02B

2 Exporter/ Address: 008236134000 TIN: Manila Int`l Container Port

EX3 1
Manifest :
BROTHER INDUSTRIES PHILIPPINES INC
LOT 1 B2 PHASE 1B FIRST PHILIPPINE INDUSTRIAL PARK 3 Page Entry Number:
BRGY ULANGO TANAUAN CITY BATANGAS PHILIPPINES Date : 10/01/2020
1
5 Items 6 Ttl Pckg. 7 Declarant Reference No.

3 8,200 XFPIP02676820A
8 Importer/ Consignee/ Address: 9 Registry Office
BROTHER INTERNATIONAL CORPORATION CANADA First Philippine Industrial Park - SEZ
LIMITED
1, RUE HOTEL DE VILLE, DOLLARD DES ORMEAUX PQ H9B 10 11 12 13
3H6 CANADA TEL5146850600 EX.4494 ATTMS.ZHENG CPR
100773764 XX XXXXX
14 Declarant Address TIN: 004669434001 15 Country of Export 15 C.E. Code 17 C.D. Code

NIPPON EXPRESS PHILIPPINES PH b CA

a XX a b
PHILIPPINES CORP. (OCD)
16 17 Country of Destination

PHILIPPINES CANADA

18 Vessel/ Aircraft 19 Ct 20 Delivery terms

JEJU ISLAND 112N 1 FOB - Free On Board XX

21 Local carrier (If Any) 22 Cur. & Total amt. invoiced 23 Exch. Rate 24 FOREX

USD 86,086.02 48.545 0 0

27 Port of Loading 28 Financial and Banking Data Bank Code : 000
25 26

XX XX PHMN2 PH Modes of Payment : 01 - Basic

29 Port Of Departure 30 Province of Origin Bank Name : Bank not Registered
P02B - Manila Int`l Container BAT - BATANGAS
Port XXXXXXX Terms of Payment :

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item 33 HS Code
Packages Marks & Nos :
and Desc. 1X40 1 No 3215.9090.000 XXXXXXXX XXXX
Of Goods No. Of Packages : 3,140
Number and Kind : PE - PIECES 34 35 Gr. mass kg 36 Pref
Containers No(s) : PH 325.70 Kg(s)
XX
TCNU2432396
- - Other 37 PROCEDURE Net mass kg 39
INK CARTRIDGE
1000 000 325.70 Kg(s) XXXXXX
40 Air Way Bill/Bill Of Lading

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

41 Suppl. Units 42 Item Customs Value (F.C.) 43

44 Add Export Clearance No. : 0.00 325.70
Infos Doc /
Produ. 0-0
Certif. & 45
Aut. A.D. : XFPIP02676820A
Corresponding import document number
46 Statistical PHP Value
663850-0 FOB value of imported raw materials

48 Account Number 49 CBW Number

47 Calcula Type Tax Base Rate Amount MP
-tion of
Taxes
47b ACCOUNTING DETAILS
.............................................................................................................................

Mode Of Payment :

Approval Number : Date :

.............................................................................................................................
Total Fees :
Total
Total Declaration :

Date/ Time Approved : 2020-10-01 08:56 AM

Date/ Time Allowed to Exit : 2020-10-01 09:26 AM 50 Declarant

Printed Name and Signature of Declarant

Place and Date

51 AUTHORIZATION 52 Bureau of Customs (BOC) Control

Name of Agency :

Printed Name/ Signature Position Printed Name/ Signature Position

Date Valid Until Date

 OFFICE OF DISPATCH/ EXPORT
1 DECLARATION Office Code:P02B
8 Importer/Consignee/Address:
BROTHER INTERNATIONAL CORPORATION CANADA EX3 1 Manila Int`l Container Port
LIMITED Manifest:
1, RUE HOTEL DE VILLE, DOLLARD DES ORMEAUX PQ 3 Page Entry Number:
H9B 3H6 CANADA TEL5146850600 EX.4494
Date : 10/01/2020
ATTMS.ZHENG CPR 100773764 2
31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
Marks & Nos : 1X40 2 8443.3990.000
and Desc.
Of Goods
XXXXXXXX XXXX
No. Of Packages : 760
34 35 Gr. mass kg 36 Pref
Number and Kind : PE-PIECES PH 7,953.20 Kg(s)
Containers No(s) :
TCNU2432396 37 PROCEDURE 38 Net mass kg 39
- - - Other 1000 000 7,953.20 Kg(s) XXXXXX
PRINTER
40

44 Add 41 Suppl. Units 42 Item FOB Price 43

Infos Doc
/ Produ. 0.00 82,836.32
Certif. &
Aut.
45
XFPIP02676820A
46 Statistical PHP value
663850-1

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
Marks & Nos : 1X4 3 8443.9990.000
and Desc.
Of Goods
XXXXXXXX XXXX
No. Of Packages : 4,300
34 35 Gr. mass kg 36 Pref
Number and Kind : PE-PIECES PH 246.90 Kg(s)
Containers No(s) :
TCNU2432396 37 PROCEDURE 38 Net mass kg 39
- - - Other 1000 000 246.90 Kg(s) XXXXXX
TAPE CASSETTE0
40

44 Add 41 Suppl. Units

Infos Doc 42 Item FOB Price 43
/ Produ. 0.00 2,924.00
Certif. &
Aut.
45
XFPIP02676820A
46 Statistical PHP value
663850-2

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
and Desc. Marks & Nos :
Of Goods
No. Of Packages :
34 35 Gr. mass kg 36 Pref
Number and Kind :
Containers No(s) :
null 37 PROCEDURE 38 Net mass kg 39
null
40

44 Add 41 Suppl. Units 42 Item FOB Price 43

Infos Doc
/ Produ.
Certif. &
Aut.
45

46 Statistical PHP value

Type Tax Base Rate Amount MP Type Tax Base Rate Amount MP
47 Calcula
-tion of
Taxes

Total first item of this rider: Total second item of this rider:

Type Tax Base Rate Amount MP Type Amount MP < RECAPITULATION

C Office of departure

Total third item of this rider: