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.

1 1,200 XFPIP02681420A
8 Importer/ Consignee/ Address: 9 Registry Office
BROTHER INTERNATIONAL CORPORATION First Philippine Industrial Park - SEZ
200 CROSSING BOULEVARD BRIDGEWATER NJ 08807 0911
USA TEL 908 704 1700 FAX 908 704 8235 10 11 12 13

XX XXXXX
14 Declarant Address TIN: 004669434001 15 Country of Export 15 C.E. Code 17 C.D. Code

NIPPON EXPRESS PHILIPPINES PH b US

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

PHILIPPINES UNITED STATES

18 Vessel/ Aircraft 19 Ct 20 Delivery terms

CAPE FLINT 067N 1 FOB - Free On Board XX

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

USD 119,796.00 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 8443.3990.000 XXXXXXXX XXXX
Of Goods No. Of Packages : 1,200
Number and Kind : PE - PIECES 34 35 Gr. mass kg 36 Pref
Containers No(s) : PH 11,880.00 Kg(s)
XX
TGBU8569030
- - - Other 37 PROCEDURE Net mass kg 39
PRINTER
1000 000 11,880.00 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. : 0.00 119,796.00
Infos Doc /
Produ. 0-0
Certif. & 45
Aut. A.D. : XFPIP02681420A
Corresponding import document number
46 Statistical PHP Value
663492-0 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 10:39 AM

Date/ Time Allowed to Exit : 2020-10-01 11:09 AM 50 Declarant

Printed Name and Signature of Declarant

BIPH / 10.01.2020
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