UNCTAD/ASYCUDAWorld A OFFICE OF

1 DECLARATION
KTM
2 Exporter No. IM 8 KATIMA MULILO
MAGNESIA SOLUTIOS LTD Customs Reference
GRAND BALE BUSINESS PARK 3 Forms 4 Load S 3425 09/06/2022
MAURITIUS
1 1 Manifest
5 Items 6 Nbr packages 7 Reference number

1 34 2022 AL582JUN

8 Consignee No. 9 Financial No.

LA MINIERE DE KALUMBWE MYUNGA S.A.S 1

KATANGA
DRC
10 Cty f. dest 11 Trading 12 Value details 13 C.A.P.

of NA cty. 144,557.00
14 Declarant No. 1001946491 15 Country of export 15 C.E. 17 C.D. Code

iCLEAR XPRESS LIMITED UNITED STATES OF a US b a CD b

NO. 886 16 Country of origin 17 Country of destination
CHIBESAKUNDA ROAD
UNITED STATES OF THE DEMOCRATIC REPUBLIC
18 Identity and nationality of means of transport at arrival / at 19 20 Delivery terms

no CIF KSU
21 Identity and nationality of active means of transport crossing the 22 Currency & total amount 23 Exch. rate 24 Nature of

N582U/N6308K/N6414K ZM USD 36,890.00 17.2750 1 transac.

25 Mode 26 Inland mode 27 Place of loading/unloading 28 Financial and banking data Bank
62 at border Transport Terms of 1 Cash
29 Office of entry/exit 30 Location of goods
KTM KATIMA MULILO KTMCUSTOMS
31 Packages Marks and numbers - Containers No(s) - Number and kind 32 Item 33 Commodity code
and
Marks & no ADD 1 No 25199000 000
descriptio
of goods STC 34 Cty. orig. 35 Gross mass (kg) 36 Prefer.
of

Number and 34 BG a US b 34,000.00

Kind BAG 37 PROCEDURE 38 Net mass (kg) 39 Quota

Containers No
8100 000 34,000.00
40 Summary declaration / Previous document S/L
Magnesia and other magnesium oxide
STC ;MAGCHEM 40 41 Supplementary units 42 Item Price 43 V.M.

44 Add. info Licence No D.Val D.Qty 36,890.00 cod

Document
Produced
138,200.00+0.00+6,357.20+0.00-0.00 A.I. Code 45 Adjustment

Certificate A.D. 1.0000

and autho- 46 Statistical value
rization
TRIP# 11043755 781,831.95
47 Calcul- Type Tax base Rate Amount M 48 Deferred payment 49 Identification of warehouse
ation of
taxes CD 781,832.00 5.000 39,092.00 0
VAT 820,924.00 16.000 131,348.00 0 B ACCOUNTING DETAILS

Mode of payment CASH

Assessment number A 9458 /1 Date 09/06/2022
Receipt number R 8636 Date 09/06/2022
Guarantee 170,440.00 ZM Date

Total fees 500.10 ZM Total MP3

Total 170,440.00 0 Total 500.10 ZM 0.00

50 Principal No. Signatur C OFFICE OF DEPARTURE

51 Intended Represented by
offices of Place and date
transit
country

52 Code 53 Office of destination and country

not valid

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

7706
Declarant name/representative
Signatur WANKUMBU CHINULA