SINGLE ADMINISTRATIVE DOCUMENT

1 DECLARATION Office Code: P12

2 Exporter /Supplier Address Port of Davao
8ZN 8 Manifest No: WHL0005-24
YESSING MACHINERY CO LTD
3 Page
NO 21 5 LANE 231 GAOMEI RD CHINGSHUEI TOWNSHIP Customs reference no.: T-148
TAICHUNG COUNTY 436 TAIWAN 1 5 Date : 04/01/2024 11:18:48
1
5 Items 6 Tot Pack 7 Reference Number

1 5 TWXB2400016
8 Importer/Consignee, Address Tin: 600006499002 9 CRF No.
HEAD SPORT PHILIPPINES INC.
C ANFLO INDUSTRIAL ESTATE, SAN VICENTE PANABO DAVAO DEL
NORTE 8105 PHILIPPINES
U 10 11 12 Tot. F/I/O 13 T. Rel.
XX XX 9,240.00
S 14 Broker/Attorney-In-Fact, Address Tin: 249050027000 15 Country of Export 15 C.E. Code 17
CHRISTLAMB REAE C. VICENTE
T GUARDSMAN BLDG., SANDAWA ROAD, NEW TAIWAN, PROVINCE OF TW
MATINA, BRGY. BUCANA CHINA
16 Country of Origin 17
O DAVAO CITY 80008000
PHILIPPINES TAIWAN, PROVINCE OF
M 18 Vessel/Aircraft Registry No. 19 Ct CHINA
20 Terms Of Delivery
WAN HAI 285 S059 WHL0005-24 1 FOB
S 21 Local Carrier (If Any) : 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thru Bank

WAN HAI 285 S059 USD 77,000.00 56.281 2

25 26 27 Transhipment Port 28 Financial and Banking Data Bank Code : 998
04/01/2024 XX PHDVO Terms of Payment : 01-Basic
1
29 Port Of Destination 30 Location Of Goods Bank Name : PCHC
ZANIE-Anflo Industrial Estate S31 Branch : NA Bank Ref No. :
Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code Rate Tariff Spec Spec Code
Marks & Nos : 5 LS-8-2G THREE IN ONE LAMINATING M
No. Of Packages : 5 1 84201090000 1.00 000000
Number and Kind : PK-PACKAGE
31 Packages Containers No(s) : 34 C.O. Code 35 Item Gross Wgt. 36 Pref
and Desc.
Of Goods WHSU6055917
- - Other TW 5,460.00 Kg(s)
Others
1X40 5 LS-8-2G THREE IN ONE LAMINATING MACHINE-DUAL GLUING GROOVES / 37 Procedure Item Net Weight 39 Quota
DUAL TANKS / NO CONVEYORS 1SET
8800 000 5,360.00 Kg(s) NNNNN
40a AWB/BL 40b Previous Doc No.

594340080253
OTHInEV : INSinFRT : Fine : 41 Suppl. Units 42 Item Customs Value (F.C.) 43 V.M.
44 Add Infos
Doc / Produ.
1 0.000 0.00
Certif. & Aut.
PCE 1.00 77,000.00 NV
433,364 + 86,673 + 0 + 186 - 601
A.I. Code 45 Adjustment

Prev Doc Reference : 1.00

MSP 46 Dutiable Value (PHP)
Invoice No. : Dump Bond :
20240315 4,853,673.44
48 Prepaid Account No. 49 Identification of Warehouse
47 Calcula- Type Tax Base Rate Amount MP
tion of Taxes
2023P12-00030
CUD 4,853,673.44 1% 48,536.73 0
47b ACCOUNTING DETAILS
VAT 4,914,643.51 12% 589,847.22 0 .............................................................................................................................
:
Mode Of Payment ACCOUNT
Assessment Number -
: PAYMENT Date :
Receipt Number : - Date :
Guarantee : 638,383.95 Date :
.............................................................................................................................
Total Fees 1,592.00
Total
638,383.95 Total Assessment 1,592.00
50 We hereby certify that the information contained in all pages of this Declaration and the documents submitted are Subscribed and sworn to before me
to the best of out knowledge and belief true and correct.

CHRISTLAMB REAE C. VICENTE HEAD SPORT PHILIPPINES INC. Administering Officer /

Notary Public
Broker Date : Importer/Attorney-In-Fact

51 AUTHORIZATION 52 Control at Office Destination

Date Print name Position Date Print name Position

 53 INTERNAL REVENUE (TAX PER BOX #46 & 47)

TAXABLE VALUE PHP 4,853,673.44 WHARFAGE 185.64 OTHERS 0.00

BANK CHARGES 0.00
ARRASTRE CHARGES 600.60 TOTAL LANDED COST PHP 4,915,393.50
CUSTOMS DUTY 48,536.73
BROKERAGE FEE 11,117.09 DOCUMENTARY STAMP 280.00 TOTAL VAT PHP 589,847.22

DESCRIPTION IN TARIFF TERMS SHOULD BE

54 SECTION 55 NO. OF PACKAGES EXAMINATION RETURN 56 DATE RECEIVED 57 DATE RELEASED

ITEM
NO DESCRIPTION IN TARIFF TERMS SHOULD BE QTY UNIT UNIT VALUE TARIFF HEADING RATE

PLEASE REFER TO RIDER/S FOR FINDINGS ON ITHER ITEMS

REVISED CHARGES LIQUIDATION

59 CHARGES 60 DECLARATION 61 FINDINGS 62 DIFFERENCES 65 LIQUIDATION AMOUNT

PHP
DUTY

BIR Taxes
66 SHORT/EXCESS
VAT PHP

Excise Tax/Ad
67 REMARKS

Others

Surcharges

TOTAL

63 ACTION DIRECTED / 64 68
RECOMMENDED
Date Date

69
Date Date

CONTINUATION FROM BOX # 31 FREE DISPOSAL

Total Item Taxes 0.00

CSF 562.00
CDS 250.00
IRS 30.00
D&F 40.00
CTF 710.00

Total Global Taxes 1,592.00

1,592.00
Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS

Terms Of Payment

Code Account

52 C2306308573507
Bank Reference Number : Selectivity Color : ORANGE Section 6
Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
TEMPORARY ASSESSMENT NOTICE

Customs Office P12 Port of Davao

Identification of the Declaration

Ref Registration Assessment Nbr of

Model Year Number Date Year Number Day/Mth Items

8ZN 8 2024 T-148 04/01/24 2024 - 1

Declarant Reference No : TWXB2400016

Declarant : 249050027000 CHRISTLAMB REAE C. VICENTE
GUARDSMAN BLDG., SANDAWA ROAD, NEW
MATINA, BRGY. BUCANA
DAVAO CITY 80008000
Importer : 600006499002 PHILIPPINES
HEAD SPORT PHILIPPINES INC.
ANFLO INDUSTRIAL ESTATE, SAN VICENTE PANABO DAVAO
DEL NORTE 8105 PHILIPPINES

Mode of Payment ACCOUNT Account Number

PAYMENT
Receipt number - Statement number and date

Total Item Taxes 0.00

CSF 562.00
CDS 250.00
IRS 30.00
D&F 40.00
CTF 710.00

Total Global Taxes 1,592.00

Total assessed amount for the declaration

Amount currently to be paid 1,592.00

This temporary Assessment Notice provides advice to the declarant of the entry number assigned to the declaration
encoded. This document is of a temporary nature. The final Assessment Notice will be issued by BOC staff.
 TRANSACTION RECEIPT

TRANSACTION RECEIPT NO. TWXB2400016

HEAD SPORT PHILIPPINES INC.

CLIENT ANFLO INDUSTRIAL ESTATE, SAN VICENTE PANABO DAVAO DEL NORTE 8105
PHILIPPINES

TIN 600006499002

TRANSACTION DETAILS

ENTRY DATE 04/01/2024 00.00.00

ENTRY NO. T-148

HOUSE NO. 594340080253

MANIFEST NO. WHL0005-24

REFERENCE NO. TWXB2400016

AMOUNT 45.00

TOTAL AMOUNT DUE FORTY FIVE PESOS ONLY

Certified correct :

CARGO DATA EXCHANGE CENTER, INC.