IEIRD Number: 3 - RED

Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS
TEMPORARY ASSESSMENT NOTICE
Customs Office: Port of Manila
Identification of the declaration
Ref - REGISTRATION ASSESSMENT Nbr of
Model Year Number Date Year Number Day/Mth Items
4 4 2019 C 33071 2019-03-12 2

Declarant: 402144172000 JEFFREY LUDOVICE MEDINA

227 AMPIOCO STREET BALUT TONDO

MANILA 1012
Reference: FW699031201
Importer: 132076824000 FASTWORTH MARKETING
39 6F GRANTS ST GSIS VILLAGE SANGAN
DAAN
QUEZON CITY 1109

Mode of Payment Account Number

CASH 010080599-0094747

Receipt number and date Statement number and date

CUD 35,842.00
VAT 123,599.00

Total Items taxes 159,441.00

IPF 1,000.00

CSF 520.00

CDS 250.00
IRS 30.00
Total global taxes 1,800.00
Total assessed amount for the declaration 161,241.00
Amount currently to be paid
This temporary Assessment Notice provides advice to the declarant of the entry
number assigned to the declaration encoded. This document is of a temporary in
nature. The final Assessment Notice will be issued by BOC Staff.