Republic of the Philippines

Department Of Finance
BUREAU OF CUSTOMS

Statement OF Settlement Of Duties And Taxes

Customs Office P12 Port of Port of Davao

Identification of the declaration

Registration Assessment

Declaration Ref Year Number Date Number Date

4 4 2019 C-7050 2019-04-04 L-29256 2019-04-05

Reference Number : J5JB1900055

Declarant : MOHAMMAD FARHAN MACARAYA SANGCAYO

462784197000 233 KLM DRIVE AIRLANE VILLAGE BRGY.
VITALEZ PARANAQUE CITY
Importer : AMG-HSS ENTERPRISE
418470305000 726 SAMPAGUITA ST MINTAL DAVAO CITY
DAVAO CITY 8000
PHILIPPINES

Receipt Number : R - 25619 Receipt Date : 2019-04-08

Mode Of Payment: CASH PAYMENT

Message No : 8902823 AAB Ref No : 010261389-1326681

Item Taxes

CUD 45838.00
VAT 48690.00

Total Item Taxes: 94528.00

Global Taxes

IPF 500.00
Other Global 807.00
Total Global Taxes: 1307.00

Total Assessed Amount: 95835.00

Collection Date : 2019-04-08T16:03:14

Mode Of Payment: NON CASH PAYMENT

IED Number : Remaining Amount :

Tax Debit Memo

TDM Number TDM Amount

Tax Credit Certificate

TCC Number : TCC Balance :

Bond Account Number:

Bonds Amount : Bonds Account Balance:

This copy is for information purposes only. This is not an official document of the Bureau of Customs and may not be used or relied upon
as basis for compliance with any legal requirement.