GOODS DECLARATION. GD-I X Custom File No.

[ ] BILL OF ENTRY [ ] BILL OF EXPORT [ ] BAGGAGE DECLARATION [ ] TRANSSHIPMENT PERMIT

2.DECLARATION TYPE 3.VALUATION 4.PREVIOUS REF
1.EXPORTER'S/CONSIGNOR'S NAME AND ADDRESS

2198
EB METHOD PQIB-IB-8472-18-12-2019
Pt Sumber Indah Perkasa 5.PAGE 1 OF 6.CUSTOM OFFICE 7.BANK CODE

Indonesia 1 MCC PMBQ - Import Bulk

8.IGM/EGM NO & DT PQIB-748-2019 Date: 17-12-2019 INDEX 21

10.IMPORTER'S/CONSIGNEE'S/PASSENGER NAME & ADDRESS 9.DRY PORT IGM/EGM NO & INDEX

DT
FAISALABAD OIL REFINERY PVT LTD 11.DECLARANT (OTHER THAN IMPORTER/EXPORTER)
NOWSHERA SHIPPING AGENCY SHOW ROOM NO 4 GROUND FL 25 PAK
JHANG ROAD CHAMBER WEST WHARF ROAD KARACHI
12.TEL 02132852087

14.NTN 15.STR.No / PASSPORT NO & DATE 13.C.H.A.L. No 2198 Job No

16.WAREHOUSE LIC NO 17.TRANSACTION TYPE
0803939 0801040500282
PWL 02/2006 False
18.DOCUMENTS ATTACHED E-Form No Date Value
19.LC/DD NO. & DATE 20.COUNTRY OF DESTINATION
INV [ ] B/G
LC/02/009/396810/23/2019 12:00:00 AM Pakistan
BL/AWB/ [ ] IT EXMP
21.CURRENCY NAME & CODE 30.MARKS/ CONTAINER NOS.
CO [ ]
US $ 840 R.B.D PALM OLEIN IN BULK
PL [ ]
22.VESSEL MODE OF 23.BL.AWL.CON.NO & DATE 24.EXCHANGE RATE
TRANSPORT BLOOMV1901TRHPQ21 11/29/2019 12:00:00 AM 155.490000
M.T. ARGENT BLOOM,
17/12/201923:00 25.PORT OF SHIPMENT 26.PAYMENT TERMS
Tarahan With LC
27.PORT OF DISCHARGE 28.PLACE OF DELIVERY 29.DELIVERY TERMS
CFR
31.NUMBER OF PACKAGES 32.TYPE OF PACKAGE 33.GR OSS WT 34.Volume M3

982000.000 KGS 982.00000 MT

35.GENERAL DESCRIPTION OF GOODS

NET WT
982.00000MT
36.IN THE CASE OF DANGEROUS GOODS INDICATE HAZARD CLASS/DIV:FLASH Containers detail as per attached sheet
POINT
37.ITEM NO 38.QUANTITY 38(b).NO OF UNITS 39.CO CODE 40.SRO NO 41.HS Code
(a)Unit Type SRO741(I)/2013-78-28/08/2013
1 982000.0000 Indonesia 1st Schedule ( Income Tax) Part II Sr 7 of the table-7-30/06/2019 1511.9030
KG 6th Schedule-24-12/06/1998
42.ITEM DESCRIPTION OF GOODS 46.LEVY 47.RATE 48.SUM PAYABLE (PKR)
RBD PALM OLEIN (IN BULK) D-QTY 982000 KGS. 100 CD 7692.5000
F 7554035.0000

ST 0.00 % 0.0000
42(a)
ACD 2.00 % 1781898.0000
43.UNIT VALUE 44.TOTAL VALUE 45.CUSTOM VALUE (PKR) %
IT 5.50 6337182.0000
Declared Assessed Declared Assessed Declared Assessed
SVT 17.00 % 16741585.0000
0.5720 0.5720 561704.0000 561704 89094876.0000 89094876.0000

37.ITEM NO 38.QUANTITY 38(b).NO OF UNITS 39.CO CODE 40.SRO NO 41.HS Code

(a)Unit Type
2

42.ITEM DESCRIPTION OF GOODS 46.LEVY 47.RATE 48.SUM PAYABLE (PKR)

42(a)

43.UNIT VALUE 44.TOTAL VALUE 45.CUSTOM VALUE (PKR)

Declared Assessed Declared Assessed Declared Assessed

49.SRO / Test Report No & Dt 50.FOB VALUE 0.0000 54.LANDING CHARGES @ 1% 1.0000 %
51.FREIGHT 0.0000 55.OTHER CHARGES 0.0000

52.CFR VALUE 561704.0000 89094876.0000

56.ASSESSED VALUE PKR
53.INSURANCE 1.0000 % 57.TOTAL REBATE CLAIM/ PROV. ASSMNT U/S 81
58.MACHINE NO. 59REVENUE RECOVER 60.AMOUNT (PKR) (PKR)
64.I/we declare that the above particulars are true & corrcect.
& DATE CODE LEVY

PQIB-EB-9159- CD 7554035.00
30-12-2019 ST 0.00
61.A.O's name, sig & stamp SIG & DATE
155.490000
ACD 1781898.00
IT 6337182.00 65..C/F/D NO & DATE
Appraiser:
XXXXXX
SVT 16741585.00 C-PQIB-001475-30122019
XXXXXX
Examiner:
Payment Received by Rehmatullah
62.P.A.s name, sig & stamp
XXXXXX
XXXXXX

63.Out of Charge Sig & Stamp

Total: 32463800.0000 66.Bank Stamp

This is a system generated document, it does not require signature or stamp” as defined in sub section (kka) of Section 2 of Customs Act 1969