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

13
HC METHOD
DEVILLBISS HEALTHCARE GMBH C/O ROUTE2HEALTH PARA PHARMACEUTICAL 5.PAGE 1 OF 6.CUSTOM OFFICE 7.BANK CODE
PRODUCTS TRADING LLC,
OFFICE 604, BURJ AL SALAM, SHEIKH ZAYED ROAD, DUBAI U.A.E 1 Karachi Air Freight Unit

8.IGM/EGM NO & DT KPAF-1975-2021 Date: 02-05-2021 INDEX 5

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

DT
PREMIER SALES (PRIVATE) LIMITED 11.DECLARANT (OTHER THAN IMPORTER/EXPORTER)
M/S FALCON EXPRESS KHAIRI MARKET BOULTON MARKET M.A.JINNAH
Plot No 1-A/15, Sector-15, Korangi Industrial Area, Karachi, Korangi Korangi ROAD
12.TEL 32428623
Town
14.NTN 15.STR.No / PASSPORT NO & DATE 13.C.H.A.L. No 13 Job No
16.WAREHOUSE LIC NO 17.TRANSACTION TYPE
6925517 3277876196185
False
18.DOCUMENTS ATTACHED E-Form No Date Value
19.LC/DD NO. & DATE 20.COUNTRY OF DESTINATION
INV [ ] B/G AHB-EIF-029921-25032021 87961.2400
1032LC57216/20213/29/2021 12:00:00 AM Pakistan
BL/AWB/ [ ] IT EXMP
21.CURRENCY NAME & CODE 30.MARKS/ CONTAINER NOS.
CO [ ]
US $ 840 607-2059-2180
PL [ ]
22.VESSEL MODE OF 23.BL.AWL.CON.NO & DATE 24.EXCHANGE RATE
TRANSPORT AAM00005016 4/29/2021 12:00:00 AM 153.900000
EY-221, 02/05/202104:30
25.PORT OF SHIPMENT 26.PAYMENT TERMS
Amsterdam-Schip 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

4.000 PACKAGES 776.00000 KG

35.GENERAL DESCRIPTION OF GOODS

NET WT
776.00000KG
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 Part II of First Schedule-3-01/07/2020
1 25.0000 United States 9019.2010
u
42.ITEM DESCRIPTION OF GOODS 46.LEVY 47.RATE 48.SUM PAYABLE (PKR)
SLEEPCUBE PLUS AUTOADJUST CPAP WITH SMARTFLEX ITEM CODE: DV54SE-P CD 3.00 % 58755.0000

ST 17.00 % 349592.0000
42(a)
ACD 2.00 % 39170.0000
43.UNIT VALUE 44.TOTAL VALUE 45.CUSTOM VALUE (PKR) %
AST 3.00 61693.0000
Declared Assessed Declared Assessed Declared Assessed
IT 5.50 % 135724.0000
503.6200 503.6200 12590.5000 12590.5 1958501.0000 1958501.0000

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

(a)Unit Type Part II of First Schedule-3-01/07/2020
2 13.0000 United States 9019.2010
u
42.ITEM DESCRIPTION OF GOODS 46.LEVY 47.RATE 48.SUM PAYABLE (PKR)
SLEEPCUBE BILEVEL ST ITEM CODE:DV56SE CD 3.00 % 61106.0000

ST 17.00 % 363580.0000
42(a)
ACD 2.00 % 40737.0000
43.UNIT VALUE 44.TOTAL VALUE 45.CUSTOM VALUE (PKR) %
AST 3.00 64161.0000
Declared Assessed Declared Assessed Declared Assessed
IT 5.50 % 141154.0000
1007.2500 1007.2500 13094.2500 13094.25 2036861.0000 2036861.0000

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 87961.2400 13682711.0000

56.ASSESSED VALUE PKR
53.INSURANCE 65.0000 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

KPAF-HC-54028- CD 410481.00
05-05-2021 ST 2442364.00
61.A.O's name, sig & stamp SIG & DATE
153.900000
ACD 273654.00
AST 431005.00 65..C/F/D NO & DATE
Appraiser:
XXXXXX
IT 948211.00 C-KPAF-000638-05052021
XXXXXX
Examiner:
Payment Received by PREMIER SALES (PRIVATE) LIMITED
62.P.A.s name, sig & stamp
XXXXXX
XXXXXX

63.Out of Charge Sig & Stamp

Total: 4505715.0000 07/05/2021 11:11 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