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 : 09/30/2020
1
5 Items 6 Ttl Pckg. 7 Declarant Reference No.

4 19,407 XFPIP02673820A
8 Importer/ Consignee/ Address: 9 Registry Office
BROTHER INTERNATIONAL BROTHER INTERNATIONAL First Philippine Industrial Park - SEZ
CORPORATION CORPORATION CANADA LIMITED
1, RUE HOTEL DE VILLE, DOLLARD DES ORMEAUX PQ H9B 10 11 12 13
3H6 CANADA TEL5146850600 EX.4494 ATT MS.ZHENG CPR
100773764 XX XXXXX
14 Declarant Address TIN: 004669434001 15 Country of Export 15 C.E. Code 17 C.D. Code

NIPPON EXPRESS PHILIPPINES PH b CA

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

PHILIPPINES CANADA

18 Vessel/ Aircraft 19 Ct 20 Delivery terms

JEJU ISLAND 112N 1 FOB - Free On Board XX

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

USD 115,895.18 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 : 763
Number and Kind : PE - PIECES 34 35 Gr. mass kg 36 Pref
Containers No(s) : PH 7,819.80 Kg(s)
XX
YMMU6153724
- - - Other 37 PROCEDURE Net mass kg 39
PRINTER
1000 000 7,819.80 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 78,480.09
Infos Doc /
Produ. 0-0
Certif. & 45
Aut. A.D. : XFPIP02673820A
Corresponding import document number
46 Statistical PHP Value
663604-0 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 08:50 AM

Date/ Time Allowed to Exit : 2020-10-01 09:20 AM 50 Declarant

Printed Name and Signature of Declarant

BIPH 10/01
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

 OFFICE OF DISPATCH/ EXPORT
1 DECLARATION Office Code:P02B
8 Importer/Consignee/Address:
BROTHER INTERNATIONAL BROTHER INTERNATIONAL EX3 1 Manila Int`l Container Port
CORPORATION CORPORATION CANADA LIMITED Manifest:
1, RUE HOTEL DE VILLE, DOLLARD DES ORMEAUX PQ 3 Page Entry Number:
H9B 3H6 CANADA TEL5146850600 EX.4494 ATT
Date : 09/30/2020
MS.ZHENG CPR 100773764 2
31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
Marks & Nos : 1X40 2 3215.9090.000
and Desc.
Of Goods
XXXXXXXX XXXX
No. Of Packages : 12,140
34 35 Gr. mass kg 36 Pref
Number and Kind : PE-PIECES PH 1,525.80 Kg(s)
Containers No(s) :
YMMU6153724 37 PROCEDURE 38 Net mass kg 39
- - Other 1000 000 1,525.80 Kg(s) XXXXXX
INK CARTRIDGE
40

44 Add 41 Suppl. Units 42 Item FOB Price 43

Infos Doc
/ Produ. 0.00 24,780.80
Certif. &
Aut.
45
XFPIP02673820A
46 Statistical PHP value
663604-1

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
Marks & Nos : 1X40 3 8443.9990.000
and Desc.
Of Goods
XXXXXXXX XXXX
No. Of Packages : 6,000
34 35 Gr. mass kg 36 Pref
Number and Kind : PE-PIECES PH 278.20 Kg(s)
Containers No(s) :
YMMU6153724 37 PROCEDURE 38 Net mass kg 39
- - - Other 1000 000 278.20 Kg(s) XXXXXX
TAPE CASSETTE
40

44 Add 41 Suppl. Units

Infos Doc 42 Item FOB Price 43
/ Produ. 0.00 4,548.00
Certif. &
Aut.
45
XFPIP02673820A
46 Statistical PHP value
663604-2

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code
Packages
and Desc. Marks & Nos : 1X40 4 8443.1900.000 XXXXXXXX XXXX
Of Goods
No. Of Packages : 504 34 35 Gr. mass kg 36 Pref
Number and Kind : PE-PIECES PH 478.90 Kg(s)
Containers No(s) :
YMMU6153724 37 PROCEDURE 38 Net mass kg 39
- - Other 1000 000 478.90 Kg(s) XXXXXX
P TOUCH
40

44 Add 41 Suppl. Units 42 Item FOB Price 43

Infos Doc
/ Produ.
Certif. &
0.00 8,086.29
Aut.
45
XFPIP02673820A
46 Statistical PHP value
663604-3

Type Tax Base Rate Amount MP Type Tax Base Rate Amount MP
47 Calcula
-tion of
Taxes

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

Type Tax Base Rate Amount MP Type Amount MP < RECAPITULATION

C Office of departure

Total third item of this rider: