EG012350922TW

From(Sender) Contract No.: To(Addressee)

Kyane Chen Chen KUO JUNG LEE

1F., Aly. 42, Ln. 34, Sec. 2, Xingnan Rd., Zhonghe Dist , 6520 13TH AVE S
Taipei MN , RICHFIELD
55423-1722 , U.S.A.

Postcode: 235
Country: TAIWAN(R.O.C.) Tel No.: 9522192057 Tel No.:9522192057 TAX ID:
IOSS VAT NO.
□ Gift □ Documents □ Commercial Sample □ Returned Goods □ Sales of Goods ■ Others Please specify
_______________
Detailed description of contents QTY Weight(kg) Value (TWD) HS tariff number Country of origin
Postage 郵資
1.Curtain 3 15.000 21000.00 TW 營業郵資券______元NTD
2.clothes 18 3.000 1800.00 TW 自備郵資券______元NTD
3. 自備郵票 ______元NTD
4.
Total Value (TWD) 22800.00
Total weight(kg) Dimension in CM Vol. weight(kg) Amount insured(TWD) Date stamp 日戳
18.000 42.0 x33.0 x5.7 1.317 0
I certify that the particulars given in this customs declaration are correct and that this item does not contain any dangerous article or articles
prohibited by legislation or by postal or customs regulations.茲證明本人所填資料屬實且無裝寄任何法律或郵政或海關法規禁止的危險物品
，如有不實，願負全部責任。

Date and Sender's signature 寄件人簽署及日期:__________________________________________________________________

Drawn by 經辦員簽署________

投遞證明聯 PROOF OF DELIVERY 本單請以PTL049交易登錄，ITMATT欄位請選「有」

EG012350922TW
From(Sender) Contract No.: To(Addressee)
Kyane Chen Chen KUO JUNG LEE

1F., Aly. 42, Ln. 34, Sec. 2, Xingnan Rd., Zhonghe Dist , 6520 13TH AVE S
Taipei MN , RICHFIELD
55423-1722 , U.S.A.

Postcode: 235
Country: TAIWAN(R.O.C.) Tel No.: 9522192057 Tel No.:9522192057 TAX ID:
IOSS VAT NO.
□ Gift □ Documents □ Commercial Sample □ Returned Goods □ Sales of Goods ■ Others Please specify
_______________
Detailed description of contents QTY Weight(kg) Value (TWD) HS tariff number Country of origin
Postage 郵資
1.Curtain 3 15.000 21000.00 TW 營業郵資券______元NTD
2.clothes 18 3.000 1800.00 TW 自備郵資券______元NTD
3. 自備郵票 ______元NTD
4.
Total Value (TWD) 22800.00
Total weight(kg) Dimension in CM Vol. weight(kg) Amount insured(TWD) Date stamp 日戳
18.000 42.0 x33.0 x5.7 1.317 0
I certify that the particulars given in this customs declaration are correct and that this item does not contain any dangerous article or articles
prohibited by legislation or by postal or customs regulations.茲證明本人所填資料屬實且無裝寄任何法律或郵政或海關法規禁止的危險物品
，如有不實，願負全部責任。

Date and Sender's signature 寄件人簽署及日期:__________________________________________________________________

Drawn by 經辦員簽署________

寄件人聯 SENDER'S COPY 本單請以PTL049交易登錄，ITMATT欄位請選「有」

 EG012350922TW
From(Sender) Contract No.: To(Addressee)
Kyane Chen Chen KUO JUNG LEE

1F., Aly. 42, Ln. 34, Sec. 2, Xingnan Rd., Zhonghe Dist , 6520 13TH AVE S
Taipei MN , RICHFIELD
55423-1722 , U.S.A.

Postcode: 235
Country: TAIWAN(R.O.C.) Tel No.: 9522192057 Tel No.:9522192057 TAX ID:
IOSS VAT NO.
□ Gift □ Documents □ Commercial Sample □ Returned Goods □ Sales of Goods ■ Others Please specify
_______________
Detailed description of contents QTY Weight(kg) Value (TWD) HS tariff number Country of origin
Postage 郵資
1.Curtain 3 15.000 21000.00 TW 營業郵資券______元NTD
2.clothes 18 3.000 1800.00 TW 自備郵資券______元NTD
3. 自備郵票 ______元NTD
4.
Total Value (TWD) 22800.00
Total weight(kg) Dimension in CM Vol. weight(kg) Amount insured(TWD) Date stamp 日戳
18.000 42.0 x33.0 x5.7 1.317 0
I certify that the particulars given in this customs declaration are correct and that this item does not contain any dangerous article or articles
prohibited by legislation or by postal or customs regulations.茲證明本人所填資料屬實且無裝寄任何法律或郵政或海關法規禁止的危險物品
，如有不實，願負全部責任。

Date and Sender's signature 寄件人簽署及日期:__________________________________________________________________

Drawn by 經辦員簽署________

原寄局留存聯 POST OFFICE COPY 本單請以PTL049交易登錄，ITMATT欄位請選「有」

EG012350922TW
From(Sender) Contract No.: To(Addressee)
Kyane Chen Chen KUO JUNG LEE

1F., Aly. 42, Ln. 34, Sec. 2, Xingnan Rd., Zhonghe Dist , 6520 13TH AVE S
Taipei MN , RICHFIELD
55423-1722 , U.S.A.

Postcode: 235
Country: TAIWAN(R.O.C.) Tel No.: 9522192057 Tel No.:9522192057 TAX ID:
IOSS VAT NO.
□ Gift □ Documents □ Commercial Sample □ Returned Goods □ Sales of Goods ■ Others Please specify
_______________
Detailed description of contents QTY Weight(kg) Value (TWD) HS tariff number Country of origin
Postage 郵資
1.Curtain 3 15.000 21000.00 TW 營業郵資券______元NTD
2.clothes 18 3.000 1800.00 TW 自備郵資券______元NTD
3. 自備郵票 ______元NTD
4.
Total Value (TWD) 22800.00
Total weight(kg) Dimension in CM Vol. weight(kg) Amount insured(TWD) Date stamp 日戳
18.000 42.0 x33.0 x5.7 1.317 0
I certify that the particulars given in this customs declaration are correct and that this item does not contain any dangerous article or articles
prohibited by legislation or by postal or customs regulations.茲證明本人所填資料屬實且無裝寄任何法律或郵政或海關法規禁止的危險物品
，如有不實，願負全部責任。

Date and Sender's signature 寄件人簽署及日期:__________________________________________________________________

Drawn by 經辦員簽署________

收件人聯 RECIPIENT'S COPY 本單請以PTL049交易登錄，ITMATT欄位請選「有」

 報關單聯
CUSTOMS DECLARATION(CN23) EG012350922TW
From(Sender) Contract No.: To(Addressee)
Kyane Chen Chen KUO JUNG LEE

1F., Aly. 42, Ln. 34, Sec. 2, Xingnan Rd., Zhonghe Dist , 6520 13TH AVE S
Taipei MN , RICHFIELD
55423-1722 , U.S.A.

Postcode:235
Country:TAIWAN(R.O.C.) Tel No.:9522192057 Tel No.:9522192057 TAX ID:
□ Gift □ Documents □ Commercial Sample □ Returned Goods □ Sales of Goods ■ Others Please specify IOSS VAT NO.
________________

Detailed description of contents QTY Weight(kg) Unit Price(TWD) Value(TWD) HS tariff no. Country of origin

1. Curtain 3 15.000 7,000.00 21,000.00 TW

2. clothes 18 3.000 100.00 1,800.00 TW

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Total Value(TWD) 22800.00

42.0 x
Total weight(kg) 18.000 Dimension in CM 33.0 x Vol. weight(kg) 1.317 Amount insured(TWD) 0
5.7
I certify that the particulars given in this customs declaration are correct and that this item does not contain any dangerous article or articles prohibited by
legislation or by postal or customs regulations.
茲證明本人所填資料屬實且無裝寄任何法律或郵政或海關法規禁止的危險物品，如有不實，願負全部責任。

Date and Sender's signature寄件人簽署及日期：________________________________