CENTRAL BANK OF NIGERIA FORM SUBMISSION ORIGINAL

FOREIGN EXCHANGE (MONITORING AND MISCELLANEOUS PROVISIONS) DECREE 1995 Page 1 of 1

Form M VALID FOR FOREX? PREFIX BANK YEAR NUMBERING APPLICATION NUMBER
(Application to Import)
YES BA 032 2024 0001185
MF20240041632

END OF VALIDITY 24/05/2025

1. Name and Address of Applicant's Banker (Authorised Dealer) Branch Details

Union Group Nigeria 00032 Headquarter

2. Applicant’s Name and Address 3. Applicant’s RC No. 4. Applicant’s TIN 5. Applicant's NEPC Reg. No.
FMCG DISTRIBUTIONS LIMITED RC886950 10240804-0001
COCOA INDUSTRIAL ROAD,OGBA IKEJA, 6. Applicant’s Phone 7. Applicant’s Fax 8. Applicant's Email
IKEJA, IKEJA, LAGOS
07056891000 david.oginni@fmcgdistribution.org
9. Beneficiary's Name and Address 10. Applican'ts State Code and Name 11. Beneficiary's Phone 12. Beneficiary's Fax
GUANGDONG ACE ROLLING NEW MATERIAL 15 LAGOS +867698519551
TECHNOLOGY CO. LTD
BUILDING 1, FUMIN ROAD NO.32,XIABIAN VILLAGE 13. Beneficiary's Email 14. By Order of
HOUJIE TOWN, GUANGDONG PROVINCE, CHINA sarah@hengfengpaper.com

15. General Description of Goods 16. Net Weight 17. Gross Weight 18. Total Number of Items
TOBACCO ROLLING PAPER ,ROLL BOND BRAND 0.000 1
19. Air Ticket Number 20. Airline 21. Route

22. ITEMS
St. of Sectoral Packages Gross Net Unit of Meas. U. Price FOB Freight,
No. HS code Description of Goods
Goods Purpose Qty Type W. (kg) W. (kg) Qty Type (USD) Value (USD) Charg. (USD)
TOBACCO ROLLING
4813900000
1 PAPER,BRAND: ROLL BOND N A0101 2,050 CT 2,050.000 U 47.12 96,596.00 11,000.00
,MODEL,20GSM WHITE PAPER
23. Total FOB Value 24. Total Freight Charges 25. Total Ancillary Charges 26. Insurance Value (Nairas) 27. Currency Code 28. Exchange Rate
96,596.00 11,000.00 208,257,548.76 USD 1,446.281
29. Total C&F Value in Figure 30. Source of Funds 31. Proforma Inv. No. 32. Proforma Inv. Date 33. Payment Date
107,596.00 C.B.N FUNDS 20240501FD 01/05/2024
34. Payment Mode 35. Transfer Mode 36. TOD 37. Shipment Date
Letters of Credit TELEGRAPHIC TRANSFER CIF
38. Mode of Transport 39. Country of Origin 40. Country of Supply 41. Port of Discharge 42. Port of Loading 43. Customs Office
1 Sea transport CN China CN China NGTIN 01TC TIN CAN ISLAND

44. Designated Bank 45. Inspection Agent

032 Union Group DI77009 NCS

46. Applicant’s Endorsement 47. Authorised Dealer’s Endorsement

Full Name Full Name

FMCG DISTRIBUTIONS LIMITED Esther Sodeinde Union Group
Stamp, Signature & Date Stamp, Signature & Date
28/05/2024 29/05/2024