BOC SINGLE ADMINISTRATIVE DOCUMENT

OFFICE OF DECLARATION
1 DECLARATION P02B
2 Exporter / Supplier Address TIN: 004627848000 Manila Intl Container Port
EX2 1
1 NUTRI-ASIA INC.
JY CAMPOS CENTRE, 9TH AVENUE COR. 3 3 Page 4
Customs Refrecence
E 1032866 10/02/2020
0TH ST., BONIFACIO GLOBAL CITY 1 2 Registry Number
TAGUIG 1634
C PHILIPPINES 5 Items
4
6 Tot Pack
1505
7 Export Declaration Number
2020 N8UTB100203
8 Importer / Consignee, Address 9 CRF : Number :
U WILBY COMMERCIAL LTD
OSEDC - One-Stop Export Documentation Center
168 170 TORBAY ROAD
MARKHAMONTARIO L3R IG6
S CANADA
10 11 12 Tot. F/I/O 13 T. Ref.

14 Declarant address TIN: 412115690000 15 Country of Export 15 C.E. Code 17 C.D. Code
T RICALYN PULLARCA ASIGNADO PHILIPPINES PH CA
409 LUCAS CUADRA STA QUITERIA
16 Country of Origin 17 Country of Destination
CALOOCAN CITY 1402
O PHILIPPINES PHILIPPINES CANADA
18 Vessel / Aircraft 19 Ct 20 Terms of Delivery
TABEA V 890E FOB | Free on board
M 21 Local Carrier (if any) 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thu Bank Trans
USD 23130.25 48.545 0
S 25 26 Province of Origin
043400000
27 Port of Loading
PHMN2 28 Financial and Banking Data - Bank Code 998
LAGUNA MANILA INTL. CONTAINER PORT Terms of Payment 01 - Basic
29 Port of Departure 30 Location of Goods
1 P02B Manila Intl Container Port
S03 - INTERNATIONAL CONTAINER
TERMINAL INC (ICTSI)
Bank Name

Branch
PCHC
NA Bank Ref Number: 010049996-8746881

31 Packages Marks and Numbers - Container No(s) 32 Item No. 33 HS Code Spec Code
and 1 21039019 000
Marks & No AS ADDRESSED
Description of Packages 1X20 CONTAINERS 34 C.O. Code 35 Item Gross Weight 36 Pref
of Goods
Number and Kind 640 CS CASE PH 10,029.00 Kg. None
Container No(s) KOCU2225189 37 Procedure 38 Item Net Weight 39 Quota
- - - Other
1000 000 10,029.00 Kg.
BANANA SAUCE/ SPAGHETTI SAUCE AND SOUR MIXES 40a AWB / BL

41 Suppl. Units

0
44 Add Infos OTHinEV : 1 INSinFRT : 1 Fine : 0
Doc / Product A.I. Code
Certif. & 0+0+0+0-0
Aut

46 Dutiable Value
A.D.
1,122,857.99
Invoice No. : 20010165 Dump Bound :

47 Calculation Type Tax Base Rate Amount MP 48 Prepaid Account Number 49 Identification of Warehouse
of Taxes
/
ACCOUNTING DETAILS

Method of Payment : CASH

Assessment Number : Date :
Receipt Number : Date :
Guarantee 0.00 Date :
Total Fees 130.00
Total Total Assessment 130.00

50 We hereby certify that the information contained in all pages Subscribed and sworn bofore me
of this Declaration and the documents submitted are to the best
of our knowledge and belief true and correct

51 AUTHO- Broker : Date : Importer / Attorney-in-Fact :

RIZATION Administering Officer
RICALYN PULLARCA ASIGNADO NUTRI-ASIA INC. Notary Public

52 Bureau of Customs (BOC) Control Code 53 Office of Destination and Country

BUREAU OF CUSTOMS (BOC) CONTROL Stamp 54 Place and date

Signature
BOC SINGLE ADMINISTRATIVE DOCUMENT
1 DECLARATION OFFICE OF DECLARATION
8 Importer / Consignee, Address TIN: 004627848000 P02B
WILBY COMMERCIAL LTD EX2 1 Manila Intl Container Port
168 170 TORBAY ROAD Customs Reference
3 Page 4
MARKHAMONTARIO L3R IG6 E 1032866 10/02/2020
CANADA 2 2
31 Packages Marks and Numbers - Container No(s) - Number and Kind 32 Item No. 33 Hs Code Spec Code
and Marks & No AS ADDRESSED 2 21039011 000
Description of Packages 1X20 CONTAINER
of Goods Number and Kind 60 CS CASE 34 C.O. Code 35 Item Gross Weight 36 Pref
Container No(s) KOCU2225189 PH 870.00 Kg. None
Goods Desc. - - - Chili sauce 37 Procedure 38 Item Net Weight 39 Quota
SWEET CHILI SAUCE 1000 000 870.00 Kg.
40a AWB / BL 40b Previous Doc No.

44 Add Infos OTHinEV : INSinFRT : Fine : 41 Suppl. Units 42 Item Customs Value (F. Cur) 43 V.M
Doc / Product 0 793.20
Certif &
Aut 46 Dutiable Value (PHP) A.I. Code 45 Adjustment
Inv. No. : 20010165 1.00
31 Packages Marks and Numbers - Container No(s) - Number and Kind 32 Item No. 33 Hs Code Spec Code
and Marks & No AS ADDRESSED 3 21032000 000
Description of Packages 1X20 CONTAINERS
of Goods Number and Kind 680 CS CASE 34 C.O. Code 35 Item Gross Weight 36 Pref
Container No(s) KOCU2225189 PH 4,641.00 Kg. None
Goods Desc. - Tomato ketchup and other tomato sauces 37 Procedure 38 Item Net Weight 39 Quota
TOMATO SAUCE/TOMATO SAUCE GUISADO 1000 000 4,641.00 Kg.
40a AWB / BL 40b Previous Doc No.

44 Add Infos OTHinEV : INSinFRT : Fine : 41 Suppl. Units 42 Item Customs Value (F. Cur) 43 V.M
Doc / Product 0 7,518.00
Certif &
Aut 46 Dutiable Value (PHP) A.I. Code 45 Adjustment
Invoice No. : 20010165 1.00
31 Packages Marks and Numbers - Container No(s) - Number and Kind 32 Item No. 33 Hs Code Spec Code
and Marks & No AS ADDRESSED 4 22090000 000
Description of Packages 1X20 CONTAINERS
of Goods Number and Kind 125 CS CASE 34 C.O. Code 35 Item Gross Weight 36 Pref
Container No(s) KOCU2225189 PH 1,617.50 Kg. NONE
Goods Desc. Vinegar and substitutes for vinegar obtained from ace 37 Procedure 38 Item Net Weight 39 Quota
VINEGAR 1000 000 1,617.50 Kg.
40a AWB / BL 40b Previous Doc No.

44 Add Infos OTHinEV : INSinFRT : Fine : 41 Suppl. Units 42 Item Customs Value (F. Cur) 43 V.M
Doc / Product 12 LTR 961.25
Certif &
Aut 46 Dutiable Value (PHP) A.I. Code 45 Adjustment
Invoice No. : 20010165 1.00
47 Calculation Type Tax Base Rate Amount MP Type Tax Base Rate Amount MP
of Taxes

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

Type Tax Base Rate Amount MP Type Amount MP

Total third item of this rider G.T.

53 INTERNAL REVENUE (TAX PER BOX #45 & #47)

TAXABLE VALUE PH 1,122,857.99 WHARFAGE OTHERS

BANK CHARGES TOTAL

ARRASTRE CHARGE
CUSTOMS DUTY LANDED COST PH x 12%

BROKERAGE FEE DOCUMENTARY STAMP TOTAL VAT PH

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINED 56 DATE RECIEVED 57 DATE RELEASED

EXAMINATION RETURN

58
ITEM TARIFF
NO DESCRIPTION IN TARIFF TERMS SHOULD BE QTY UNIT UNIT VALUE HEADING RATE

PLEASE REFER TO RIDERS FOR FINDINGS ON OTHER ITEMS

REVISED CHARGES LIQUIDATION

59 CHARGES 60 DECLARATION 61 FINDINGS 62 DIFFERENCES 65 LIQUIDATED Amount

Duty
BIR Taxes 66 SHORT/EXCESS
VAT
Excise Tax/Ad Valorem 67 REMARKS
Others
Surcharges
TOTAL
63 ACTION DIRECTED/RECOMMENDED 64 68

DATE COO III DATE

69

DATE COO V DATE

CONTINUATION FROM BOX # 31 FREE DISPOSAL

Container Numbers continuation: