OFFICE OF DISPATCH/ EXPORT

Export Single Administrative Document

1 DECLARATION Office code : P02B

2 Exporter/ Address: TIN: 004706120000 Manila Int`l Container Port

EX3 1
Manifest :
DENSO PHILIPPINES CORPORATION
3 Page Entry Number:
109 UNITY AVENUE, CARMELRAY INDUSTRIAL PARK 1,
4037 CANLUBANG 1 Date : 10/01/2020
5 Items 6 Ttl Pckg. 7 Declarant Reference No.

1 3,467 XCIP101024820A
8 Importer/ Consignee/ Address: 9 Registry Office
P.T. DENSO SALES INDONESIA Carmelray Industrial Park I - SEZ
JL. GAYA MOTOR 1, SUNTER II, KEL SUNGAI BAMBU
TANJUNG PRIOK,JAKARTA UTARA, JAKARTA 14330 10 11 12 13
INDONESIA
XX XXXXX
14 Declarant Address TIN: 237471625000 15 Country of Export 15 C.E. Code 17 C.D. Code

EDISON C. OCOL PHILIPPINES PH b ID

a XX a b
16 17 Country of Destination

PHILIPPINES INDONESIA

18 Vessel/ Aircraft 19 Ct 20 Delivery terms

SEASPAN NEW YORK 006S 1 FOB - Free On Board XX

21 Local carrier (If Any) 22 Cur. & Total amt. invoiced 23 Exch. Rate 24 FOREX
ONE USD 75,826.51 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 LAG - LAGUNA
Port XXXXXXX Terms of Payment :

31 Marks and Numbers - Containers No(s) - Number and Kind 32 Item 33 HS Code
Packages Marks & Nos : AS ADDRESSED
and Desc. 1 No 9029.2090.000 XXXXXXXX XXXX
Of Goods No. Of Packages : 3,467
Number and Kind : PE - PIECES 34 35 Gr. mass kg 36 Pref
Containers No(s) : PH 3,802.17 Kg(s)
XX
TGHU5272441
- - Other 37 PROCEDURE Net mass kg 39
INSTRUMENT CLUSTER COMPUTER SA TRANSMITTER GAUGE ASSY
FUEL SENDER 1000 000 1,905.57 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 75,826.51
Infos Doc /
Produ. 0-0
Certif. & 45
Aut. A.D. : XCIP101024820A
Corresponding import document
46 Statistical PHP Value
409764 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 11:23 AM

Date/ Time Allowed to Exit : 2020-10-01 11:53 AM 50 Declarant

Printed Name and Signature of Declarant

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