This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau

of Customs nor be relied upon as basis

for compliance with any legal requirement.
TEMPORARY SINGLE ADMINISTRATIVE DOCUMENT 1 DECLARATION Office Code: P07
2 Exporter /Supplier Address Port of Cebu
4 4
CARGILL SIAM LIMITED Manifest No: EGP0066-23
130-132 SIDHORN BUILDING TOWER 3 24TH FLOOR WITTAYU ROAD 3 Page Entry Number :
LUMPINI PATHUMWAN BANGKOK 10330 Date : 09/20/2023 23:26:25
1 5
1
5 Items 6 Tot Pack 7 Reference Number
1 740 2R9A2300187

8 Importer/Consignee, Address Tin: 000669525000 9 CRF No.

C HAMBURG TRADING CORPORATION
LOT 1 AND 2 BLOCK 2 MERIDIAN INDUSTRIAL COMPLEX BRGY.
U MACABLING
10 11 12 Tot. F/I/O 13 T. Rel.
STA. ROSA LAGUNA
4026 XX XX 632.18
S PHILIPPINES
14 Broker/Attorney-In-Fact, Address Tin: 288687704000 15 Country of Export 15 C.E. Code 17
ETHELYN CAUZON DELA CRUZ THAILAND TH
T 1104 DONA VICTORIA BLDG429 UN
COR LM GUERRERO ST BRGY 666 16 Country of Origin 17
O ZONE 72
ERMITA MANILA1000 THAILAND
PHILIPPINES
M 18 Vessel/Aircraft Registry No. 19 Ct 20 Terms Of Delivery

UNI ADROIT 0610 666S EGP0066-23 1 CFR

S
21 Local Carrier (If Any) : 22 F. Cur. Total Customs Value 23 Exch Rate 24 Thru Bank
USD 17,950.00 56.908 2

25 26 27 Transhipment Port 28 Financial and Banking Data Bank Code : 998

09/23/2023 XX Terms of Payment : 01-Basic
1
29 Port Of Destination 30 Location Of Goods Bank Name : PCHC
P07-Port of Cebu S06 Branch : NA Bank Ref No. : 010041677-1027776

Marks and Numbers - Containers No(s) - Number and Kind 32 Item No. 33 HS Code Rate Tariff Spec Spec Code
Marks & Nos : 1 X 20 CARGILL
No. Of Packages : 1 35051090000 0.00 000014
740
Number and Kind : BG-BAG
31 Packages Containers No(s) : 34 C.O. Code 35 Item Gross Wgt. 36 Pref
and Desc.
Of Goods
EITU0255690
- - Other TH 18,722.00 Kg(s) AFTA
Modified Tapioca Starch
C CREAMAX 75345 MODIFIED TAPIOCA STARCH 37 Procedure Item Net Weight 39 Quota

4000 000 18,500.00 Kg(s) NNNNN

40a AWB/BL 40b Previous Doc No.

EGLV050300719032

44 Add Infos OTHInEV : 1 INSinFRT : 0 Fine : 0.00 41 Suppl. Units 42 Item Customs Value (F.C.) 43 V.M.
Doc / Produ.
Certif. & Aut. 0.00 17,950.00 NV
31,299.40 + 4,676.70 + 0.00 + 636.55 - 2,059.42
A.I. Code 45 Adjustment

Prev Doc Reference : 1.00

MSP 46 Dutiable Value (PHP)

Invoice No. : 10250138 Dump Bond : 1,057,474.70

48 Prepaid Account No. 49 Identification of Warehouse

47 Calcula- Type Tax Base Rate Amount MP
tion of Taxes

CUD 1,057,474.70 0% 0.00 1 47b ACCOUNTING DETAILS

.............................................................................................................................
VAT 1,067,822.51 12% 128,138.70 1 Mode Of Payment : CASH
Assessment Number : Date :
AVT 1
Receipt Number : Date :
EXC 0.00 1 Guarantee : Date :
.............................................................................................................................
Total Fees 1,030.00
Total 128,138.70
Total Assessment 129,168.70
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.

ETHELYN CAUZON DELA CRUZ HAMBURG TRADING CORPORATION 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

This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

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

TAXABLE VALUE PHP 1,057,474.70 WHARFAGE 636.55 OTHERS 1,000.00

BANK CHARGES 0.00

ARRASTRE CHARGES 2,059.42 TOTAL LANDED COST PHP 1,067,822.51
CUSTOMS DUTY 0.00

6,371.84 DOCUMENTARY STAMP 280.00 TOTAL VAT PHP 128,138.70

BROKERAGE FEE

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

CUD 0.00
VAT 128,138.70
AVT 0.00
Total Items Taxes 128,138.70

SGL
IPF 1,000.00
IRS 30.00
CSF

Total Global Taxes 1,030.00

This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS

Terms Of Payment

Code Account
This document is for information purposes only and shall NOT be submitted or used for processing at the Bureau of Customs nor be relied
upon as basis for compliance with any legal requirement.

Bank Reference Number : 010041677-1027776 Section : 13

Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
TEMPORARY ASSESSMENT NOTICE

Customs Office P07 Port of Port of Cebu

Identification of the Declaration

Ref Registration Assessment Nbr of

Model Year Number Date Year Number Day/Mth Items

4 4 2023 09/20/23 2023 20/Septem 1

ber

Declarant Reference No : 2R9A2300187

Declarant : 288687704000 ETHELYN CAUZON DELA CRUZ

1104 DONA VICTORIA BLDG429 UN
COR LM GUERRERO ST BRGY 666
ZONE 72
ERMITA MANILA1000
Importer : 000669525000 PHILIPPINES
HAMBURG TRADING CORPORATION
LOT 1 AND 2 BLOCK 2 MERIDIAN INDUSTRIAL COMPLEX BRGY.
MACABLING
STA. ROSA LAGUNA
4026
PHILIPPINES
Mode of Payment CASH Account Number

Receipt number Statement number and date

CUD 0.00
EXC 0.00
VAT 128,138.70
AVT 0.00

Total Items taxes 128,138.70

IPF
1,000.00
IRS 30.00

Total global taxes 1,030.00

Total assessed amount for the declaration

Amount currently to be paid 129,168.70

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.