SINGLE ADMINISTRATIVE DOCUMENT

1 DECLARATION Office Code: P04

2 Exporter /Supplier Address Port of Batangas
4ES 4 Manifest No: MSK0148-19
SAN SOON SENG FOOD INDUSTRIES SDN B
AL 308,LOT 590&LOT 4196,JALAN INDUS KAMPUNG BARU 3 Page
Customs reference no.: C-18396
SERI SUNGAI BULOH 4700 SELANGOR DARUL EHSAN
1 1 5 Date : 12/09/2019 09:42:14
5 Items 6 Tot Pack 7 Reference Number / Client Reference Number

1 80 6Q6A1900360 N19-02368
8 Importer/Consignee, Address Tin: 005031842000 9 CRF No.
CPW PHILIPPINES INC.
C 31 PLAZA DRIVEROCKWELL CENTER
MAKATI 1200
U 1200
PHILIPPINES 10 11 12 Tot. F/I/O 13 T. Rel.
S XX XX 766.80
14 Broker/Attorney-In-Fact, Address Tin: 200135486000 15 Country of Export 15 C.E. Code 17
T GILBERT PUNONGBAYAN DE CASTRO
231 M.F. JHOCSON ST., SAMPALOC, MAN MALAYSIA MY
O ILA 16 Country of Origin 17
MANILA 10081008
M PHILIPPINES MALAYSIA
18 Vessel/Aircraft Registry No. 19 Ct 20 Terms Of Delivery
S
MCC HA LONG 947N MSK0148-19 0 CIF
21 Local Carrier (If Any) : 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thru Bank

N.A. USD 14,569.20 50.859 2

25 26 27 Transhipment Port 28 Financial and Banking Data Bank Code : 998
12/07/2019 XX Terms of Payment : 01-Basic
1
29 Port Of Destination 30 Location Of Goods Bank Name : PCHC
P04-Port of Batangas S08 Branch : NA Bank Ref No. : 010070017-2945006
Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code Rate Tariff Spec
Marks & Nos : 1X20 CONTAINER STC
1 17023020000 0.00
No. Of Packages : 80
31 Packages 34 C.O. Code 35 Item Gross Wgt. 36 Pref
and Desc.
Of Goods
Number and Kind : NE-
UNDETERMINED/UNPACKED/UNPA MY 24,680.00 Kg(s) AFTA
Containers No(s) : KAGED 37 Procedure Item Net Weight 39 Quota
MSKU7358162
- - Glucose syrup 000 24,000.00 Kg(s) NNNNN
4000
80 NE AAA GLUCOSE SYRUP A301 40a AWB/BL 40b Previous Doc No.

587804320
OTHInEV : INSinFRT : Fine : 41 Suppl. Units 42 Item Customs Value (F.C.) 43 V.M.
44 Add Infos
Doc / Produ.
1 0.000 0.00
Certif. & Aut.
0.00 14,569.20 1
31,199 + 7,800 + 0 + 519 - 3,727
45 Adjustment

Prev Doc Reference : 1.00

46 Dutiable Value (PHP)
Invoice No. : Dump Bond :
3009238 779,973.62
48 Prepaid Account No. 49 Identification of Warehouse
47 Calcula- Type Tax Base Rate Amount MP
tion of Taxes

CUD 779,973.62 0% 0.00 1 47b ACCOUNTING DETAILS

.............................................................................................................................
VAT 791,524.94 12% 95,021.00 1 Mode Of Payment
:
CASH
Assessment Number : L-26045 Date : 12/09/2019
Receipt Number : - Date :
Guarantee : Date :
.............................................................................................................................
Total Fees 2,534.00
Total
95,021.00 Total Assessment 97,555.00
50 We hereby certify that the information contained in all pages of this Declaration and the documents submitted are Subscribed and sworn to before me
to the best of out knowledge and belief true and correct.

GILBERT PUNONGBAYAN DE CASTRO CPW PHILIPPINES INC. Administering Officer /

Notary Public
Broker Date : Importer/Attorney-In-Fact

51 AUTHORIZATION 52 Control at Office Destination

Date Print name Position Date Print name Position

 53 INTERNAL REVENUE (TAX PER BOX #46 & 47)

TAXABLE VALUE PHP 779,973.62 WHARFAGE 519.00 OTHERS 1,000.00

BANK CHARGES 0.00
ARRASTRE CHARGES 3,727.00 TOTAL LANDED COST PHP 791,524.59
CUSTOMS DUTY 0.00
6,024.97 DOCUMENTARY STAMP 280.00 TOTAL VAT PHP 95,021.00
BROKERAGE FEE

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINED EXAMINATION RETURN 56 DATE RECEIVED 57 DATE RELEASED

ITEM
NO DESCRIPTION IN TARIFF TERMS SHOULD BE QTY UNIT UNIT VALUE TARIFF HEADING RATE

PLEASE REFER TO RIDER/S FOR FINDINGS ON ITHER ITEMS

REVISED CHARGES LIQUIDATION

59 CHARGES 60 DECLARATION 61 FINDINGS 62 DIFFERENCES 65 LIQUIDATION AMOUNT

PHP
DUTY

BIR Taxes
66 SHORT/EXCESS
VAT PHP
Excise Tax/Ad
Valorem 67 REMARKS

Others

Surcharges

TOTAL

63 ACTION DIRECTED / 64 68
RECOMMENDED
Date Date

69
Date Date

CONTINUATION FROM BOX # 31 FREE DISPOSAL

CUD 0.00
VAT 95,021.00

Total Item Taxes 95,021.00

SGL 1,000.00
IPF 1,000.00
CDS 250.00
IRS 30.00
CSF 254.00
Total Global Taxes 2,534.00

97,555.00
Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS

Terms Of Payment

Code Account
Bank Reference Number : 010070017-2945006 Selectivity Color : BLUE Section : 1B
Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
TEMPORARY ASSESSMENT NOTICE

Customs Office P04 Port of Batangas

Identification of the Declaration

Ref Registration Assessment Nbr of

Year Number Date Year Number Day/Mth Items
Model

4ES 4 2019 C-18396 12/09/19 2019 L-26045 09/Decembe 1

r
Client Reference No : N19-02368
Declarant Reference No : 6Q6A1900360
Declarant : 200135486000 GILBERT PUNONGBAYAN DE CASTRO
231 M.F. JHOCSON ST., SAMPALOC, MAN
ILA
MANILA 10081008
PHILIPPINES
Importer : 005031842000 CPW PHILIPPINES INC.
31 PLAZA DRIVEROCKWELL CENTER
MAKATI 1200
1200
PHILIPPINES

Mode of Payment : CASH Account Number

Receipt number and - Statement number and date

date :

CUD 0.00
VAT 95,021.00

Total Item Taxes 95,021.00

SGL 1,000.00
IPF 1,000.00
CDS 250.00
IRS 30.00
CSF 254.00
Total Global Taxes 2,534.00

Total assessed amount for the declaration

Amount currently to be paid 97,555.00

This temporary Assessment Notice provides advice to the declarant of the entry number assigned to the declaration
encoded. This document is of a temporary nature. The final Assessment Notice will be issued by BOC staff.
 TRANSACTION RECEIPT

TRANSACTION RECEIPT NO. 6Q6A1900360

CPW PHILIPPINES INC.

CLIENT 31 PLAZA DRIVEROCKWELL CENTER
MAKATI 1200
1200
PHILIPPINES

TIN 005031842000

TRANSACTION DETAILS

ENTRY DATE 12/09/2019 00.00.00

ENTRY NO. C-18396

HOUSE NO. 587804320

MANIFEST NO. MSK0148-19

REFERENCE NO. 6Q6A1900360

AMOUNT 45.00

TOTAL AMOUNT DUE FORTY FIVE PESOS ONLY

Certified correct :

CARGO DATA EXCHANGE CENTER, INC.