PEDIMENT Page 1 of 2

NUM. PEDIMENT: T. OPER C PEDIMENT: REGIME: E CERTIFICATIONS

DESTINATION: TYPE CHANGE: GROSS WEIGHT:
CUSTOMS:
MEANS OF TRANSPORTATION DOLLAR VALUE:
INPUT/OUTPUT: ARRIBO: OUTPUT: CUSTOMS VALUE:
PRICE PAID:
IMPORTER/EXPORTER DATA
RFC: NAME, DENOMINATION OR CORPORATE NAME:
CURP:
ADDRESS:
VAL.INSURANCE INSURANCE FLETES PACKAGING OTHER INCREMENTAL

ELECTRONIC ACKNOWLEDGEMENT SECTION KEY

VALIDATION: CUSTOMS OF
OFFICE:

MARKS, NUMBERS AND TOTAL NUMBER OF PACKAGES:

DATES RATES AT THE PEDIMENTO LEVEL
CONTRIB. CVE. T. RATE RATE

LIQUIDATION TABLE
CONCEPT F.P. AMOUNT CONCEPT F.P. AMOUNT TOTALS
CASH
OTHER
TOTAL
SUPPLIER OR BUYER DATA
ID. FISCAL NAME, COMPANY NAME OR CORPORATE NAME ADDRESS: BONDING

NUM. INVOICE DATE INCOTERM CURRENCY FACT VAL.MON.FACT FACTOR MON.FACT VAL.DOLLARS

RECIPIENT'S DATA
ID. FISCAL NAME, COMPANY NAME OR CORPORATE NAME ADDRESS:

TRANSPORT IDENTIFICATION: COUNTRY:

NUMBER (WAYBILL/ORDER)/ID:
NUMBER / TYPE OF CONTAINER:
KEY / COMPL. IDENTIFIER
REMARKS

CUSTOMS BROKER, CUSTOMS AGENT OR WAREHOUSE AGENT I DECLARE UNDER OATH TO TELL THE TRUTH IN THE

CARRILLO GONZÁLEZ TERMS OF THE PROVISIONS OF ARTICLE 81 OF

RFC: CAGM610601163 CURP: CUSTOMS LAW; PATENT OR AUTHORIZATION: 3

AGENT/AUTHORIZED PERSON
NAME:
RFC: CURP:
AUTOGRAPH SIGNATURE
3

CERTIFICATE SERIAL NUMBER: 00001001000000101873239

ADVANCED ELECTRONIC SIGNATURE:
"The payment of the contributions can be made through the "Centralized Electronic Customs Payment" (PECA) service, in accordance with the provisions of rule 1.6.2.The customs broker or customs agent who uses the PECA service must print the bank
certification in the corresponding field of the customs declaration or in the official document, in accordance with Appendix 20 "Certification of Centralized electronic payment" of Annex 22.
The importer-exporter may request certification of the information contained in this customs declaration at: Administración General de Aduanas, Administración Aduanera "7", AV. Hidalgo No. 77, Modulo IV, PB, Col. Guerrero, CP, 06300, Mexico, DF."
ANNEX TO THE REQUEST Page 2 of 2
NUM. PEDIMENT: T.OPER: CVE PEDIM: RFC:

ITEMS
FRACTION SUBD. VINC. MET VAL UMC QUANTITY UMC UMT AMOUNT UMT P. V/C P. O/D
SEC DESCRIPTION (VARIABLE LINES AS REQUIRED) CON. RATE T.T. F.P. AMOUNT
VAL ADU/USD IMP. PRICE PAGE. PRICE UNIT. VAL. AGREG. VAT

************** END OF REQUEST ************NUM. TOTAL OF TARTIDAS: 1 *************** PREVALIDATOR KEY: 010

CUSTOMS BROKER, CUSTOMS AGENT OR WAREHOUSE AGENT I DECLARE UNDER OATH TO TELL THE TRUTH, IN THE

TERMS OF THE PROVISIONS OF ARTICLE 81 OF

RFC: CAGM610601163 CURP: CUSTOMS LAW; PATENT OR AUTHORIZATION: 3

AGENT/AUTHORIZED PERSON
NAME:
RFC: CURP:
CERTIFICATE SERIAL NUMBER:

AUTOGRAPH SIGNATURE

ADVANCED ELECTRONIC SIGNATURE:

Second copy: "importer or exporter" country Destination/Origin: Interior

of