‫‪United Arab Emirates‬‬ ‫ﺩﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫*‪*20241102014063‬‬
‫‪PORT TYPE‬‬ ‫‪ 4‬ﻧﻮﻉ ﺍﻟﻤﻨﻔﺬ‬ ‫‪DEC TYPE‬‬ ‫‪ 2 DEC NO‬ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ ‪ 3 DEC DATE‬ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫‪ 1‬ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬
‫‪Customs Declaration‬‬ ‫ﺑﺮﻱ‪ /‬ﺟﻤﺮﻙ ﻣﺰﻳﺪ‬ ‫ﺗﺼﺪﻳﺮ ‪Export‬‬ ‫‪05-11-2024‬‬ ‫‪20241102014063‬‬ ‫ﺑﻴﺎﻥ ﺟﻤﺮﻛﻲ‬
‫‪NET WEIGHT‬‬ ‫‪ 7 IMPORTER \ EXPORTER‬ﺍﻟﻮﺯﻥ ﺍﻟﺼﺎﻓﻲ‬ ‫‪ 6 DELIVERY ORDER NO.‬ﺍﻟﻤﺴﺘﻮﺭﺩ‪ /‬ﺍﻟﻤﺼﺪﺭ‬ ‫‪ 5‬ﺭﻗﻢ ﺇﺫﻥ ﺍﻟﺘﺴﻠﻴﻢ‬
‫‪20950 Kgs‬‬ ‫ﺟﻴﻨﺪﺍﻝ ﺳﻮ ﺟﻠﻒ ﺫ ﻡ ﻡ ‪770398‬‬ ‫‪25338551 05-11-2024 1‬‬

‫‪GROSS WEIGHT‬‬ ‫‪ 10 INTERCESSOR CO.‬ﺍﻟﻮﺯﻥ ﺍﻟﻘﺎﺋﻢ‬ ‫‪ 9 CARRIER'S\CAPTAIN\DRIVER‬ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﺳﻴﻄﺔ‬ ‫‪ 8‬ﺍﻟﻨﺎﻗﻠﺔ‪/‬ﺍﻟﻘﺒﻄﺎﻥ‪/‬ﺍﻟﺴﺎﺋﻖ‬

‫‪20950 Kgs‬‬ ‫ﺑﻮﺍﺳﻄﺔ ﺍﻟﺒﺮ ‪A91‬‬ ‫ﻣﺤﻤﺪ ﻋﻤﺮﺍﻥ ﻣﺤﻤﺪ ﺍﺳﻠﻢ‪/‬ﺑﺎﻛﺴﺘﺎﻥ‬
‫ﻻﺳﺘﻌﻤﺎﻻﺕ ﻭﻛﻴﻞ ﺍﻟﻨﺎﻗﻠﺔ‬

‫‪MEASUREMENT‬‬ ‫ﺍﻟﻘﻴﺎﺱ‬ ‫‪13 COMMERCIAL REG No.‬‬ ‫‪ 12 CARRIER'S NAME‬ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ ‫‪ 11‬ﺇﺳﻢ ﺍﻟﻨﺎﻗﻠﺔ‬
‫‪0‬‬ ‫ﺍﺩﺳﻮ ﺫ ﻡ ﻡ ‪C189‬‬ ‫ﺩﺑﻲ‪/‬ﺭﻳﻨﻮﻟﺖ ﺗﺮﻳﻠﻪ‪66927/‬‬
‫‪NO.OF PACKAGES‬‬ ‫ﺍﻟﻤﺼﺪﺭ‪/‬ﺍﻟﻤﺼﺪﺭ ﺇﻟﻴﻪ ‪ 16 EXPORTER / EXPORTER TO‬ﻋﺪﺩ ﺍﻟﻄﺮﻭﺩ‬ ‫‪15 VOYAGE/ FLIGHT No‬‬ ‫ﺭﻗﻢ ﺍﻟﺮﺣﻠﺔ‬ ‫‪14‬‬
‫‪40 NOS‬‬ ‫ﺟﻠﻔﺎﺭ ﻟﻠﻬﻨﺪﺳﺔ ﻭﺍﻟﻤﻘﺎﻭﻻﺕ ﺵ‪.‬ﻡ‪.‬ﻉ‪.‬ﻉ‬ ‫‪66927‬‬
‫‪MARKS & NUMBERS‬‬ ‫‪ 19 PORT OF LOADING‬ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻷﺭﻗﺎﻡ‬ ‫ﻣﻴﻨﺎﺀ ﺍﻟﺸﺤﻦ‬ ‫‪18 B\L-AWB No.\MANIF.‬‬ ‫‪ 17‬ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ‪/‬ﺍﻟﻤﻨﺎﻓﺴﺖ‬
‫‪CARRIER'S AGENT USE‬‬

‫‪ :‬ﺷﻬﺎﺩﺓ ﻣﻨﺸﺄ ﺭﻗﻢ‬ ‫ﺟﻤﺮﻙ ﻣﺰﻳﺪ‬ ‫‪-/8044014639‬‬

‫‪MOE-C0O-CICO-0165518-20241015‬‬ ‫‪ //‬ﺍﻧﺎﺑﻴﺐ ﺣﺪﻳﺪ ﺍﻟﺪﻛﺘﺎﻳﻞ ﻭﺍﻟﻤﻠﺤﻘﺎﺕ ‪//‬‬
‫‪PORT OF DISCHARGE‬‬ ‫‪ 20‬ﻣﻴﻨﺎﺀ ﺍﻟﺘﻔﺮﻳﻎ‬
‫‪OMAN‬‬

‫‪DESTINATION‬‬ ‫‪ 21‬ﺟﻬﺔ ﺍﻟﻤﻘﺼﺪ‬

‫ﻋﻤﺎﻥ‪OMN/‬‬

‫ﺍﺟﻤﺎﻟﻲ ﺍﻟﺮﺳﻮﻡ‬ ‫‪31‬‬ ‫ﻧﻮﻉ‬ ‫‪30‬‬ ‫‪29‬‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻟﻤﺤﻠﻴﺔ‬ ‫‪28‬‬ ‫ﺍﻟﻌﻤﻠﺔ ‪CURRENCY‬‬ ‫‪25‬‬ ‫‪24‬‬ ‫‪22‬‬
‫ﺍﻻﻳﺮﺍﺩ‬ ‫ﻭﺻﻒ ﺍﻟﺒﻀﺎﻋﺔ‬ ‫‪23‬‬ ‫ﺑﻨﺪ ﺍﻟﺘﻌﺮﻓﺔ‬
‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻷﺟﻨﺒﻴﺔ‬ ‫ﺑﻠﺪ ﺍﻟﻤﻨﺸﺄ‬ ‫‪GOODS DESCRIPTION‬‬
‫‪TOTAL DUTY‬‬ ‫ﻓﺌﺔ ﺍﻟﺮﺳﻢ‬ ‫‪CIF LOCAL VALUE‬‬
‫‪INCOME‬‬ ‫ﺍﻟﺴﻌﺮ‬ ‫‪ 26‬ﺍﻟﻨﻮﻉ ‪27‬‬ ‫‪H.S. CODE‬‬
‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪TYPE‬‬ ‫‪D.RATE‬‬ ‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪VALUE‬‬ ‫‪FOREIGN VALUE‬‬ ‫‪ORIGIN‬‬
‫‪TYPE‬‬

‫‪0‬‬ ‫‪0‬‬ ‫‪62139‬‬ ‫‪3.6725 USD‬‬ ‫‪16920‬‬ ‫‪UAE‬‬ ‫ﻣﻮﺍﺳﻴﺮ ﻭﺃﻧﺎﺑﻴﺐ ﻭﺃﺷﻜﺎﻝ ﺧﺎﺻﺔ )ﺑﺮﻭﻑ‬ ‫‪730300000000‬‬ ‫‪1‬‬
‫ﻹﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﻤﺴﺘﻮﺭﺩ ﺃ‬

‫‪2‬‬
‫‪3‬‬
‫‪4‬‬
‫‪5‬‬

‫ﺭﻣﺰ ﺍﻻﻋﻔﺎﺀﺍﺕ‬ ‫‪42‬‬ ‫‪AIP‬‬ ‫‪ WEIGHT‬ﻡ‪.‬ﻡ‪.‬ﺿﺎﺭﺓ‬ ‫‪ ITEM‬ﺍﻟﻮﺯﻥ‬ ‫‪ PACKAGES‬ﺍﻟﺼﻨﻒ‬ ‫ﺍﻟﻄﺮﻭﺩ‬ ‫‪CUSTOMS RESTRICTIONS‬‬ ‫ﺍﻟﻘﻴﻮﺩ ﺍﻟﺠﻤﺮﻛﻴﺔ‬
‫‪EXEMPTION OF DUTY‬‬ ‫ﺍﻟﻘﺎﺋﻢ ‪ 37A‬ﺍﻟﻨﺸﺮﺓ ‪ 37B‬ﺍﻟﺮﺳﻢ‬ ‫‪37‬‬ ‫‪ 36‬ﺍﻟﺼﺎﻓﻲ‬ ‫‪35‬ﻭﺣﺪﺓ‬ ‫‪ 32‬ﺍﻟﻜﻤﻴﺔ ‪ 33‬ﺍﻟﻨﻮﻉ ‪ 34‬ﺍﻟﻜﻤﻴﺔ‬ ‫ﻣﺮﺟﻊ ﺍﻟﻔﺴﺢ‬ ‫‪41‬‬ ‫ﺍﻟﺠﻬﺔ‬ ‫‪40‬‬
‫‪IMPORTER OR BROKER USE‬‬

‫‪Duty‬‬ ‫‪No.‬‬ ‫‪GROSS‬‬ ‫‪NET‬‬ ‫‪UNIT‬‬ ‫‪QTY‬‬ ‫‪TYPE‬‬ ‫‪QTY‬‬ ‫‪RELEASE REF‬‬ ‫‪AGENCY‬‬
‫‪1‬‬
‫‪2‬‬
‫‪3‬‬
‫‪4‬‬
‫‪5‬‬

‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪DUTY‬‬ ‫ﺍﻟﺮﺳﻮﻡ‬ ‫‪CLEARING AGENT‬‬ ‫‪ 43‬ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ ﺍﻟﻤﻮﺣﺪ ﻟﻠﻤﺴﺘﻮﺭﺩ‪/‬ﺍﻟﻤﺼﺪﺭ‪ 38 Unified Customs Code‬ﺍﻟﻤﺨﻠﺺ ﺍﻟﺠﻤﺮﻛﻲ‬
‫ﺍﻟﺮﺳﻮﻡ ﺍﻟﺠﻤﺮﻛﻴﺔ ‪TOTAL DUTY‬‬ ‫‪48‬‬ ‫ﺳﻌﺪ ﺍﻟﻠﻪ ﻛﺎﻣﻞ ﺑﺸﻮﺭ ‪CE0455‬‬
‫‪0 VAT‬‬ ‫‪ 48A‬ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
‫‪LICENCE No.‬‬ ‫‪ 39‬ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬
‫‪0 EXCISE TAX‬‬ ‫‪ 48B‬ﺿﺮﻳﺒﺔ ﺍﻧﺘﻘﺎﺋﻴﺔ‬ ‫ﺍﺩﺳﻮ ﺫ ﻡ ﻡ ‪C189‬‬
‫‪Anti Dumping‬‬ ‫‪ 48C‬ﺭﺳﻢ ﻣﻤﺎﺭﺳﺎﺕ ﺿﺎﺭﺓ‬ ‫‪GCC AEO Code‬‬ ‫‪ 44‬ﺭﻣﺰ ﺍﻟﻤﺸﻐﻞ ﺍﻻﻗﺘﺼﺎﺩﻱ ﺍﻟﻤﻌﺘﻤﺪ ﺍﻟﺨﻠﻴﺠﻲ‬
‫‪0 HANDLING‬‬ ‫‪ 49‬ﺭﺳﻮﻡ ﺍﻟﻤﻨﺎﻭﻟﺔ‬
‫ﻹﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﺠﻤﺎﺭﻙ‬

‫‪450OTHER CHARGES‬‬ ‫‪ 50‬ﺭﺳﻮﻡ ﺍﺧﺮﻯ‬

‫‪DEFINITE‬‬ ‫‪450‬‬ ‫‪ 51‬ﻗﻄﻌﻲ‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺮﺳﻮﻡ‬ ‫‪EXIT PORT‬‬ ‫‪ 46 OTHER REMARKS‬ﺟﻤﺮﻙ ﺍﻟﺨﺮﻭﺝ‬ ‫ﻣﻼﺣﻈﺎﺕ ﺃﺧﺮﻯ‬ ‫‪45‬‬
‫‪CIF‬‬ ‫‪62,139 Dhs‬‬
‫‪INSURED‬‬ ‫‪0‬‬ ‫‪ 52 TOTAL FEE‬ﺗﺄﻣﻴﻦ‬

‫‪PAYMENT METHOD‬‬ ‫ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬ ‫‪53‬‬

‫‪NO.‬‬ ‫‪ 54‬ﺭﻗﻢ‬
‫‪CUSTOM'S USE‬‬

‫‪2110634166 CR‬‬ ‫‪ 47‬ﺭﻣﺰ ﺍﻻﺳﺘﺠﺎﺑﺔ ﺍﻟﺴﺮﻳﻌﺔ‬

‫‪DATE‬‬ ‫‪05-11-2024 14:18‬‬ ‫‪ 55‬ﺗﺎﺭﻳﺦ‬
‫‪BANK‬‬ ‫‪ 56‬ﺑﻨﻚ‬
‫‪QR Code‬‬
‫‪RECEIPT NO.‬‬ ‫‪ 57‬ﺭﻗﻢ ﺃﻳﺼﺎﻝ ﺍﻟﺪﻓﻊ‬
‫‪DATE‬‬ ‫‪ 58‬ﺗﺎﺭﻳﺦ‬
‫‪BANK‬‬ ‫‪ 59‬ﺑﻨﻚ‬
‫‪14063/2024‬‬ ‫‪Insp‬‬ ‫‪C189Z‬‬ ‫‪C189Z‬‬ ‫‪Pre-Clear Bill‬‬

‫*‪*25338551‬‬
 ‫‪United Arab Emirates‬‬ ‫ﺩﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫‪Customs Declaration‬‬ ‫‪PORT TYPE‬‬ ‫‪ 4‬ﻧﻮﻉ ﺍﻟﻤﻨﻔﺬ‬ ‫‪DEC TYPE‬‬ ‫‪ 3‬ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫‪DEC DATE‬‬ ‫‪ 2 DEC NO‬ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ‬ ‫‪ 1‬ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﺑﻴﺎﻥ ﺟﻤﺮﻛﻲ‬
‫ﺟﻤﺮﻙ ﻣﺰﻳﺪ‬ ‫ﺗﺼﺪﻳﺮ ‪Export‬‬ ‫‪05-11-2024‬‬ ‫‪20241102014063‬‬

‫ﻣﺤﻤﺪ ﻋﻤﺮﺍﻥ ﻣﺤﻤﺪ ﺍﺳﻠﻢ‬ ‫ﺑﺎﻛﺴﺘﺎﻥ‬ ‫‪66927‬‬ ‫ﺩﺑﻲ‬ ‫ﺭﻳﻨﻮﻟﺖ ﺗﺮﻳﻠﻪ‬ ‫ﺍﻟﺸﺎﺣﻨﺎﺕ‪/‬ﺍﻟﺴﺎﺋﻘﻴﻦ‬

‫‪ :‬ﺷﻬﺎﺩﺓ ﻣﻨﺸﺄ ﺭﻗﻢ‬ ‫ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻻﺭﻗﺎﻡ‬

‫‪MOE-C0O-CICO-0165518-20241015‬‬

‫‪ //‬ﺍﻧﺎﺑﻴﺐ ﺣﺪﻳﺪ ﺍﻟﺪﻛﺘﺎﻳﻞ ﻭﺍﻟﻤﻠﺤﻘﺎﺕ ‪//‬‬ ‫ﻭﺻﻒ ﺍﻟﺒﻀﺎﻋﺔ‬

‫‪59271411‬‬ ‫ﺗﺼﺎﺭﻳﺢ ﺍﻟﺴﺎﺋﻖ‬

‫‪Truck No.‬‬ ‫‪66927‬‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬

‫‪Driver Name‬‬ ‫ﻣﺤﻤﺪ ﻋﻤﺮﺍﻥ ﻣﺤﻤﺪ ﺍﺳﻠﻢ‬ ‫ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ‬
‫‪Driver Nat.‬‬ ‫ﺑﺎﻛﺴﺘﺎﻥ‬ ‫ﺟﻨﺴﻴﺔ ﺍﻟﺴﺎﺋﻖ‬
‫‪BCP Req. No.‬‬ ‫‪REQ_8999932‬‬ ‫ﺭﻗﻢ ﺍﻟﻄﻠﺐ‬
‫‪BCP Arrival Date‬‬ ‫‪05-11-2024 02:00 PM‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻮﺻﻮﻝ‬
‫‪Truck Direction‬‬ ‫ﺧﺮﻭﺝ ‪ -‬ﺟﻤﺮﻙ ﻣﺰﻳﺪ‬ ‫ﺍﺗﺠﺎﻩ ﺍﻟﺸﺎﺣﻨﺔ‬
‫‪2110634166‬‬ ‫ﺭﻗﻢ ﺍﻹﺷﻌﺎﺭ‬
‫‪05-11-2024‬‬ ‫ﺗﺎﺭﻳﺨﻪ‬ ‫ﺇﺷﻌﺎﺭ ﻣﺪﻳﻦ‬ ‫ﺟﻤﺮﻙ ﻣﺰﻳﺪ‬
‫‪DEBIT NOTE‬‬
‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﻮﺭﺩ‬
‫ﺷﺮﻛﺔ ﺍﺩﺳﻮ ﻟﻠﺘﺨﻠﻴﺺ ﺍﻟﺠﻤﺮﻛﻲ‪413630/‬‬

‫‪Amount‬‬ ‫ﺍﻟﻤﺒﻠﻎ‬
‫ﺩﺭﻫﻢ‬ ‫ﻓﻠﺲ‬
‫ﺃﺭﺑﻌﻤﺎﺋﺔ ﻭ ﺧﻤﺴﻮﻥ ﺩﺭﻫﻢ ﻓﻘﻂ ﻻ ﻏﻴﺮ‬ ‫‪Dhs.‬‬ ‫‪Fils‬‬
‫‪450‬‬
‫‪C189Z 05-11-2024 14:18‬‬ ‫‪Pre-Clear Debit‬‬
‫‪Due Date‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻹﺳﺘﺤﻘﺎﻕ‬ ‫‪PRECLEARANCE OPERATION‬‬

‫‪30-01-2025‬‬ ‫ﻣﺴﺆﻭﻝ ﺍﻹﻳﺮﺍﺩﺍﺕ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﻠﻢ‬

‫ﺍﻟﻤﺒﻠﻎ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫ﺍﻟﻤﺒﻠﻎ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬
‫‪450‬‬ ‫‪14063‬‬ ‫ﺗﺼﺪﻳﺮ‬