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EXPORT ENTRY DECLARATION OFFICE OF DISPATCH / EXPORT


1 DECLARATION
Office code: P02B Manila Intl Container Port
2 Exporter/ Address TIN: 683907003000
IONICS EMS INC. EX3 1 Manifest Number:
5/6 CIRCUIT STREET LISPP I, 3 Page 4 Export Entry
SEPZ Number: -8164 Date: Apr 04 2019
CABUYAO, LAGUNA
5 Items 6 Ttl Pack 7 Declarant Reference No.
PEZA 00-39 2019 22819-04
8 Importer/Consignee/ Address 9 Registry Office
ORPAK SYSTEM INDIA - WAREHOUSE LSP1 - Light Industry Sci. Park 1
3, Deccan Warehouse xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
C/o V- Trans, Vadgaon, Telegaon
Telegaon PUNE India 10 11 12 13
xx xxxx
17 C.D.
14 Declarant/ Address TIN: 000343803000 15 Country of Export 15 C.E. Code
Code
DHL GLOBAL FORWARDING PHILS. INC. PHILIPPINES a PH b xx IN
8F STAR CRUISES CTR,100 ANDREWS AVE
NEWPORT CYBERTOURISM ZON,PASAY CITY 16 17 Country of Destination
PHILIPPINES
1309 PHILIPPINES INDIA
18 Vessel/Aircraft: 19 Ct 20 Delivery Terms
LOBIVIA V.086W 0 EXW Ex works
21 Local carrier (if Any) 22 Cur. & Total Amt. Invoiced 23 Exch Rate 24
DHL GLOBAL FORWARDING USD 85,009.6 1.0
25 No. of LCL 26 No. of FCL 27 Port of Loading 28 Financial and Banking Data Bank Code: 998

xx PHMN2 MANILA INT'L.


7 Terms of Payment: 01 Basic
CONTAINER PORT

29 Port of Departure 30 Location of goods Bank name:


P02B Manila Intl Container Port LAG LAGUNA Branch Bank Ref. No:
31 Packages Marks and Numbers - Containers No(s)- Number and kind 32 Item 33 H.S. Code
and Desc. of Marks & no : As addressed 1 No. 84718010 000
Goods
34 35 Gr. mass kg 36
PH xx 1,564 xxxx
of packages : 7 PLTS
Nbr & Kind : 7 PK 38 Net mass
37 PROCEDURE 39
kg
Containers no(s): 1000 000 1,564 xxxx
40 AWB / Bill of Lading
- - Control and adaptor units
MODULE - PCBA 2019 4B 110 NHV.
42 Itm FOB
41 Suppl. units 43 Val Method
Price
44 Add Infos/ Export Clearance No.: PCE 2,080
85,009.6
Doc/Produ
Certif & Aut A.D.
45 Adjustment
INV #
Reference No.: X-LSP1-008164-19-E 46 Statistical PHP Value
47 Calculation Type 49 Identification of
Tax base Rate Amount MP 48 Prepaid Account Number
of Taxes of Warehouse
Fees B
Method of Payment: CASH
Assessment Number : Date:
Total Fees :
Total Assessment :
DATE/TIME Approved 04/04/2019 04:42:47 PM 50 Exporter/Declarant
DATE/TIME Allowed to Exit: 04/04/2019 05:12:47 PM
IONICS EMS INC.

|2019ZLSP1EP008164(~
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
Date Valid Until

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