ZIMBABWE REVENUE AUTHORITY A CLEARANCE OFFICE

Bill of Entry Form 21 1 DECLARATION

ZWVF
2 Exporter No. IM 4 VICTORIA FALLS CUSTOM HOUSE
REVIN ZAMBIA LIMITED Customs Reference
NDOLA 3 Forms 4 Load List C 567 03/11/2018
ZAMBIA
1 1 Manifest
5 Items 6 Nbr packages 7 Reference number

1 5,700 2018 YCF0128VF

8 Consignee No. 0200005549 9 Financial No.

FE-TATMIF ENTERPRISES PVT LTD

T/A GREENS SUPERMARKET
BOX 9134
BULAWAYO
Cty.s last 11 Trading 12 Value details 13 C.A.P.

ZM con. ZM cty. 718.20

No. 15 Country of export 15 C.E. Code 17 C.D. Code
14 Declarant 0200102113
Darkstorm Investments (Pvt) Ltd Zambia a ZM b a ZW b
445 Miles Road 16 Country of origin 17 Country of destination
Victoria Falls
Zambia Zimbabwe
18 Identity and nationality of active means of transport at 19 Ctr. 20 Delivery terms

ADS9300/AAS9311/AAZ1189 ZW no FOB NDOLA

21 Identity and nationality of active means of transport crossing the border 22 Currency & total amount invoiced 23 Exch. rate 24 Nature of

ADS9300/AAS9311/AAZ1189 ZW USD 11,970.00 1.0000 transac.

25 Mode 26 Inland mode 27 Place of discharge 28 Financial and banking data Bank
30 at border Transport Terms of

29 Office of entry 30 Location of goods

ZWVF VICTORIA FALLS LOC07
31 Packages Marks and numbers - Containers No(s) - Number and kind 32 Item 33 Commodity code
and
Marks & no VF/PRC/47/11/18 1 No. 22029000 000
description
of goods 34 Cty. orig. 35 Gross mass (kg) 36 Prefer.
of

Nbr & Kind 5,700 06 a ZM b CSA

Cartons/Boxes 37 PROCEDURE 38 Net mass (kg) 39 Quota

Containers No
4000 000 29,640.00
40 Summary declaration / Previous document S/L
Other non-alcoholic beverages, nes
JUICY SOFT DRINKS 41 Supplementary units 42 Item Price 43 V.M.

44 Add. info Licence No OGIL D.Val D.Qty 30 27,360.00 11,970.00 cod

Documents
Produced
598.50+0.00+119.70+0.00-0.00 A.I. 45 Adjustment

Certificates A.D. 1.0000

and autho- 46 Statistical value
rization
12,688.20
47 Calcul- Type Tax base Rate Amount MP 48 Account Code 49 Identification of warehouse
ation of
taxes 101 12,688.200 0.000 0.00 1 W0200102113
102 12,688.200 15.000 1,903.23 1 B ACCOUNTING DETAILS

Mode of payment ACCOUNT PAYMENT

Assessment A 17322 / Date 04/11/2018
Receipt number R 45640 Date 04/11/2018
Guarantee 0.00 Date

Total fees 10.00 USD

Total 1,903.23 1 Total declaration 1,913.23 USD

50 Principal No. Signature C OFFICE OF DEPARTURE

Represented by
Place and date Code

Darkstorm Inv t/a Yacht Clearing-tshabangunelson

I ......................................................................................................................... the undersigned
Darkstorm Investments (Pvt) Ltd
being the representant for ................................................................................................... hereby declare that the
information and particulars contained herein are true and complete and accept fully the conditions and requirements
attaching to the use of CPCs.
53 Office of destination and country
03/11/2018
Signature ...................................................................... Date .......................................

Darkstorm Inv t/a Yacht 04/11/2018 54 Place and date

Printed by: on Stamp:
Clearing-tshabangunelson

Declarant name/representative
Darkstorm Inv t/a Yacht Clearing-