BOC SINGLE ADMINISTRATIVE DOCUMENT

2 Exporter /Supplier Address

BROOKLYN ENTERPRISE PTE LTD

50 COLLYER QUAY #06-04 OUE BAYFRONT SINGAPORE

3 Page

5 Items

6 Tot Pack

1
C
U
S
T
O
M
S

8 Importer/Consignee, Address

000272097000

Tin:

18 Vessel/Aircraft

Registry No.

TB HENRY/BG CHRISTY

15 C.E. Code

17

INDONESIA
20 Terms Of Delivery

CFR
Total Customs Value

USD

XX
S06

32 Item No.

Marks & Nos :

IN BULK
No. Of Packages : 1
Number and Kind : VO-BULK,SOLID,LARGE

01-Basic
Bank Ref No. :

PARTICLES(NODULES)

ID
4000

Rate

27011290000

37 Procedure

- - - Other

Tariff Spec

0.00

35 Item Gross Wgt.

36 Pref

8,012,662.00
Kg(s)
Item Net Weight

39 Quota

000

AFTA

8,012,662.00
Kg(s)
40b Previous
Doc No.

40a AWB/BL

INDONESIAN STEAM COAL

010533457-0002172

33 HS Code

34 C.O. Code

Containers No(s) :

Bank Code :

Bank Name : PCHC

Branch :
NA

Marks and Numbers - Containers No(s) - Number and Kind

24 Thru Bank

47.069
998

660,964.49

Terms of Payment :

P07-Port of Cebu

23 Exch Rate

28 Financial and Banking Data

27 Transhipment Port

30 Location Of Goods

17

ID

16 Country of Origin

29 Port Of Destination

13 T. Rel.

1,241.29

INDONESIA

22 F. Cur.

26

12 Tot. F/I/O

XX

15 Country of Export

TB HENRY/BG CHRISTY

31 Packages
and Desc.
Of Goods

11

XX

21 Local Carrier (If Any) :

85ZA1500282

10

19 Ct

PTG0010-15

7 Reference Number

9 CRF No.

TAIHEIYO CEMENT PHILIPPINES INC.

6F INSULAR LIFE BLDG.GORORDO AVENUE
CEBU
CEBU 6000
6000
PHILIPPINES
14 Broker/Attorney-In-Fact, Address
Tin:
948121346000
JERVY M. LABORES
VILLA FATIMA, MAGUIKAY
MANDAUE6014
PHILIPPINES

25

Office Code:
P07
Port of Cebu
Manifest No: PTG0010-15
Customs reference no.: C-33026
Date :
12/03/2015 08:45:03

1 DECLARATION

NNNNN

312BMSSEX112015
44 Add Infos
Doc / Produ.
Certif. & Aut.

OTHInEV :

INSinFRT :

Fine :

0.000

41 Suppl. Units

0.00

42 Item Customs Value (F.C.)

1.00

0 + 58,426 + 0 + 272,431 - 881,393

43 V.M.

660,964.49

45 Adjustment

1.00

Prev Doc Reference :

46 Dutiable Value (PHP)

Invoice No. :

47 Calculation of Taxes

Type

CUD
EXC
VAT

Dump Bond :

006/MA/INV/EX/XI/
2015
Tax Base

31,169,363.8
6

Rate

Amount

0.00
80,126.00
3,893,830.
00

0%
12%

32,368,463.8
9
Total

3,973,956.00

31,169,363.86
MP

1
1
1

48 Prepaid Account No.

49 Identification of Warehouse

47b ACCOUNTING DETAILS

.............................................................................................................................
:
Mode Of Payment
CASH
Assessment Number
Date : 12/04/2015
: L-50346
Receipt Number
Date :
: Guarantee
Date :
:
.............................................................................................................................
Total Fees
1,265.00
Total Assessment

3,975,221.00

50 We hereby certify that the information contained in all pages of this Declaration and the documents submitted are
to the best of out knowledge and belief true and correct.

JERVY M. LABORES
Broker

Administering Officer /
Notary Public

TAIHEIYO CEMENT PHILIPPINES INC.

Date :

Importer/Attorney-In-Fact

52 Control at Office Destination

51 AUTHORIZATION

Date

Subscribed and sworn to before me

Print name

Position

Date

Print name

Position

53 INTERNAL REVENUE (TAX PER BOX #46 & 47

BANK CHARGES

31,169,363.86
0.00

CUSTOMS DUTY

0.00

TAXABLE VALUE PHP

44,011.70

BROKERAGE FEE

WHARFAGE

272,431.00

OTHERS

ARRASTRE CHARGES

881,393.00

TOTAL LANDED COST PHP

265.00

DOCUMENTARY STAMP

1,000.00
32,368,464.56
3,893,830.00

TOTAL VAT PHP

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION

55 NO. OF PACKAGES EXAMINED

ITEM
DESCRIPTION IN TARIFF TERMS SHOULD BE
NO

EXAMINATION RETURN
QTY

56 DATE RECEIVED
UNIT

UNIT VALUE

57 DATE RELEASED
TARIFF HEADING

1
PLEASE REFER TO RIDER/S FOR FINDINGS ON ITHER ITEMS
REVISED CHARGES
59 CHARGES

60 DECLARATION

61 FINDINGS

LIQUIDATION
62 DIFFERENCES

65 LIQUIDATION AMOUNT
PHP

DUTY
BIR Taxes

66 SHORT/EXCESS
PHP

VAT
Excise Tax/Ad

67 REMARKS

Others
Surcharges
TOTAL

63 ACTION DIRECTED /
RECOMMENDED

64
Date

68
Date
69

Date

CONTINUATION FROM BOX # 31

CUD
EXC
VAT

Date

FREE DISPOSAL

0.00
80,126.00
3,893,830.00

Total Item Taxes

IPF
D&F

3,973,956.00
1,000.00
265.00

Total Global Taxes

1,265.00
3,975,221.00

RATE

Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS

Terms Of Payment
Code

Account

010533457-0002172

Bank Reference Number :

Selectivity Color :

Section

GREEN

11

Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS

ASSESSMENT NOTICE
Customs Office

P07

Port of Cebu
Identification of the Declaration

Model

Ref
Year

Registration
Number
Date

Year

Number

2015

C-33026

2015

L-50346

Declarant Reference No :

12/03/15

Assessment
Day/Mth

Nbr of
Items

04/Decembe
r

85ZA1500282

Declarant : 948121346000

JERVY M. LABORES
VILLA FATIMA, MAGUIKAY
MANDAUE6014
PHILIPPINES

Importer :

TAIHEIYO CEMENT PHILIPPINES INC.

6F INSULAR LIFE BLDG.GORORDO AVENUE
CEBU
CEBU 6000
6000
PHILIPPINES

000272097000

Mode of Payment :

CASH

Account Number

Receipt number

Statement number and date

CUD
EXC
VAT

0.00
80,126.00
3,893,830.00

Total Item Taxes

IPF
D&F

3,973,956.00
1,000.00
265.00

Total Global Taxes

1,265.00

Total assessed amount for the declaration

Amount currently to be paid

3,975,221.00

TRANSACTION RECEIPT

TRANSACTION RECEIPT NO.

CLIENT

TIN

85ZA1500282

TAIHEIYO CEMENT PHILIPPINES INC.

6F INSULAR LIFE BLDG.GORORDO AVENUE
CEBU
CEBU 6000
6000
PHILIPPINES
000272097000

TRANSACTION DETAILS
ENTRY DATE

12/03/2015 00.00.00

ENTRY NO.

C-33026

HOUSE NO.

312BMSSEX112015

MANIFEST NO.

PTG0010-15

REFERENCE NO.

85ZA1500282

AMOUNT

45.00

TOTAL AMOUNT DUE

FORTY FIVE PESOS ONLY

Certified correct :
CARGO DATA EXCHANGE CENTER, INC.