ETHIOPIAN CUSTOMS

COMMISSION
DECLARATION FORM

1 DECLARATION A. CLEARANCE OFFICE AA KALITY (AAK)

2 Consignor/Exporter No Office Code Manifest Number
GUANGZHOU ANSEN CHEMICAL CO., LTD IM 4 AAK00

3 Forms 4 Loading Lists Registration number & date Assessment number & date
1 1
5 Items 6 Tot. Pkgs. 7 Declarant Reference number Receipt number & date
1 1080 2021 / PVL0837
8 Consignee/Importer No 0066812342 No 10 Country of Last
9 Person responsible for financial settlement
ZHONGFEI HAITIAN CHEMICAL MANUFACTU CN Consign.
EIC-IP/26529/2012
OROMIA 11 Trading

country
15 Country of dispatch/export 15 C. disp./exp. code 17 Country destin. code

China a CN b a ET b ET
14 Declarant No 0045014036 16 Country of origin 17 Country of destination Section
PAVE LOGISTICS AND TRADING PLC China Ethiopia MF
RG: ADDIS ABABA ZN :ARADA
WR: NO WOREDA-139 KB :WERODA 01 20. Delivery Terms Business Activity
FOB FI
18 Identity and nationality of means of transport at arrival 19 Ctr. 22 Currency and total amount invoiced 23 Exchange rate 24 Nature of
CHAB EXPRESS TRANSIT X USD 7,290.00 41.101 transactio
21 Identity and nationality of active means of transport crossing the border 28 Financial and banking data 24 Invoice Details
Bank Code Currency Amount
Ex. Freight ETB 59,728.00
25 Mode of transport 26 Inland mode 27 Place of Loading
at the border of transport
Branch Terms of Payment Insurance ETB 355.00
61 3 Nansha Pt CNNSA
0 FRANCO Other ETB 23,469.00
29 Office of entry/exit 30 Location of goods
B. P. number and date In. Freight ETB 9,281.00
GAL00 GALAFI (GAL) Total ETB 92,833.00
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 1 No 28273200 000 0000 0000
description
of goods FCIU4292960 Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36 Preference
Ctr.
No(s) 1080 BG Bag a CN b 27000
Description of goods 42 a 37 PROCEDURE 38 Net mass (kg) 39 Quota
--Aluminium chloride Ex. Freight 59,728.00 4000 402 27000
POLY ALUMINIUM CHLORIDE Insurance 355.00 40 Summary declaration/Previous document / Way bill
Other Costs 23,469.00
In. Freight 9,281.00
41 Supplementary units 42 Item price 43 V.M.

44 Additional 7,290.00 Code

License number Deducted Quantity Deducted Value
Information/ A.I. Code 45 Adjustment
Produced
documents Attached document codes 1
001 004 005 006 007 018 320 46 Statistical Value
Proc. Program
392,459.00
Type Duty/Tax Base Rate Amount MP 48 Account No / Deferred Payment 49 Warehouse code / period
47 Taxes &
duties 01 392,459.00 10 39,245.90 1
03 431,705.00 0 0.00 1 Summary of Payables
04 431,705.00 15 64,755.75 1 Amount

05 496,461.00 0 0.00 1 Total duties & taxes 104,276.37

15 392,459.00 0 0.00 1 Guarantee amount 0.00
16 392,459.00 0.070000000000000 274.72 1 Total fees 0.00
Other 0.00
Total Payable 104,276.37
Total 104,276.37 1
50 Declaration C OFFICE OF DEPARTURE

I, Jebessa Benti Metensa (AG1053), the undersigned of PAVE LOGISTICS AND TRADING PLC RG:
ADDIS ABABA ZN :ARADA WR: NO WOREDA-139 KB :WERODA 01 do hereby declare that the
information and particulars declared are true and complete and accept fully the condition and requirements
attaching to the use of CPC declared here in and hold myself liable for any inaccurate information.

Signature Date & stamp Address

52 Guarantee Code 53 Office of destination (and country)

not valid for

D CONTROL BY OFFICE OF DEPARTURE Stamp: 54 Place and date:

Result:

Seals affixed: Number:

Signature and name of declarant/representative
Identity:
Jebessa Benti Metensa (AG1053)
Time limit (date):

Signature:
 ETHIOPIAN CUSTOMS
COMMISSION
DECLARATION FORM - List of Containers

1 DECLARATION A. CLEARANCE OFFICE

Office Manifest Number
IM 4
AAK00

3 Forms 5 Items Registration number & date Assessment number & date

1 1

# Container Reference Item No Type E/F Other characteristics

1 FCIU4292960 1 20GP 1/1 FJ11070785
 ETHIOPIAN REVENUES AND CUSTOMS AUTHORITY DECLARATION FORM

Assessment Notice
Customs Office: AAK00 AA KALITY (AAK)

Identification of the declaration

Declarant Assessment
Model Customs reference Nbr of Items
reference reference
IM 4 2021 / PVL0837 1

Declarant: Company: Bank:

0045014036 0066812342

PAVE LOGISTICS AND TRADING PLC ZHONGFEI HAITIAN CHEMICAL MANUFACTU

RG: ADDIS ABABA ZN :ARADA EIC-IP/26529/2012
WR: NO WOREDA-139 KB :WERODA 01 OROMIA

Mode of payment Account Number Receipt number & date Statement number & date

CASH

Item Taxes Global Taxes

01 Import Customs Tax 39,245.90
03 Excise Tax 0.00
04 Value Added Tax 64,755.75
05 Goods Liable to 10% Surtax 0.00
15 Goods Liable To 3% Withholding Tax 0.00
16 Goods Liable to 0.07% Scanning Fee 274.72

Total Item taxes 104,276.37 Total Global taxes 0.0

Total assessed amount of declaration 104,276.37

Amount null 104,276.37