EAST AFRICAN COMMUNITY SINGLE ADMINISTRATIVE DOCUMENT(SAD)-ICMS A CUSTOMS OFFICE C.
17C
1DECLARATION
24NBOEX113916525
1 2 Consignor/Exporter PIN/TIN EX1
KE NBO NEX
KE P051129234X 3 Page Of 4 Total gr. mass
Laborex Kenya Limited 1 2 18.3000
5 Total Items 6 Total packages 7 Reference number
72030 - 00200 MOMBASA ROAD NAIROBI KE 2 2
8 Consignee PIN/TIN 9a Total freight 9b Total insurance
TZ 0.0000
LABOREX TANZANIA LIMITED 9c Total Other Charges 9d Total Customs Value
784,940.0000
DAR ES SALAAM /TANZANIA PO BOX 70032 TANZANIA 12 Valuation method
CUSTOMS OFFICE
1
14 Declarant/Representative PIN/TIN 15a Country of Last Consignment 16 Date of exit/arrival
KE P051107490D KE 12/5/24 12:00 AM
TABAKI FREIGHT SERVICES INTERNATIONAL LIMITED
17a Country of Destination 17b Region of destination code (Kenya
66222 - 00800 MODERN RELIANCE INDUSTRIES LTD NAIROBI CITY (WEST) TZ county)
Declarant ref.number CAL/000757/20
18 Identity and nationality of means of transport at departure/on 19 Ctr. 20 Delivery terms
arrival
0 FOB NAIROBI
21 Identity and nationality of active means of transport crossing the border 22 Currency and total amount invoiced 23 Exchange rate
KES 784940 1
25 Mode of transport 26 Inland mode 27 Place of 28 Financial and banking data
loading/unloading
4 Air at the border 4 Air of transport
29 Office of exit / entry 30 Location of goods
1 NBO JKA
Marks and numbers - Container No(s) - Number and kind 32 Item 33 Commodity HS Code
001 No 30049000
Type Reference Quantity Marks Gross weight Description of 34 Country origin Code 35 Gross mass (kg) 36 Preference
MALANIL ADULT a KE 1.3
BX 1 1 AWB 1.3
TABS 12'S
31 37 P R O C E D U R E 38 Net mass (kg) 39 Quota
Packages 1.3
1000 101
and
structured 40 Previous document 41a Supplementary units
description
of goods 1.3 KGM
41b Supplementary units 42 Item price
Manifest registration Prefix of the TD 102440
Bill code Commercial description of the goods
number
MEDICINES; MALANIL ADULT TABS 12'S;
BX; 40; 12'S; ADULT; 40; H;
Tariff Other Medicaments (excluding goods of heading 30.02, 30.05 or 30.06) consisting of
description of mixed or unmixed products for therapeutic or prophylactic uses, put up in mea
the goods
44 NAME AVALUE NAME AVALUE
Additional 45a FOB value 45b Freight value 45c Insurance cost
information _PPB_VMD H BrandName MEDICINES
Document CommonName MALANIL ADULT TABS PackagingMode BX
s 102440 0 0
QuantityOrNbOfPacka 40 Strength 12'S
produced/
Certificat TherapeuticProphylac ADULT Volume 40 45d Other Charges 46 Customs value
0 102440
Tax Type Tax Base Rate Amount MP 48 Deferred payment 49 Identification of warehouse
2801/ Export Duty 102,440.00 0 0.00 A
47 Total Tax due for this item: 0.00 B ACCOUNTING DETAILS Tax Type TAX_AMOUNT MP
Calculation
of taxes Totals all item 0.00 2801/ Export Duty 0.00 A
B.No Total Tax due : 0.00
Amount
50 Principal No C OFFICE OF DEPARTURE
51
Intended
Represented
offices of
transit Place and
52 Remarks 53 Office of destination (and country)
D/J CONTROL BY OFFICE OF DEPARTURE/DESTINATION Stamp: 54 Place and date:
Result:
Seals affixed: Signature and name of declarant/representative:
Identity:
Time limit (date):
Signature:
I/We null the undersigned of TABAKI FREIGHT SERVICES INTERNATIONAL LIMITED being the agent/principal of Laborex Kenya Limited do hereby declare that the information and
particulars declared herein are true and complete.
Signature and stamp
Place: 66222 - 00800 MODERN RELIANCE INDUSTRIES LTD NAIROBI CITY (WEST) KE
Tel/Fax:
1 of 2
EAST AFRICAN COMMUNITY SINGLE ADMINISTRATIVE DOCUMENT(SAD)-ICMS A CUSTOMS OFFICE C.17C(Cont.)
CUSTOMS
1DECLARATION
EX1
3 Page Of
1
2 2
Marks and numbers - Container No(s) - Number and kind 32 Item 33 Commodity HS Code
002 No 30024100
Type Reference Quantity Marks Gross weight Description of 34 Country origin Code 35 Gross mass (kg) 36 Preference
HEXAXIM 1SYR a KE 17
BX 1 1 AWB 17 TAN 20 HM 0426
37 P R O C E D U R E 38 Net mass (kg) 39 Quota
31 17
1000 101
Packages
and 40 Previous document 41a Supplementary units
description
of goods 17 KGM
41b Supplementary units 42 Item price
Manifest registration Prefix of the TD 682500
Bill code Commercial description of the goods
number
VACCINE; HEXAXIM 1SYR TAN 20 HM
0426;
Tariff
description of --Vaccines for human medicine
the goods
44 NAME AVALUE NAME AVALUE
Additional 45a FOB value 45b Freight value 45c Insurance cost
information BrandName VACCINE CommonName HEXAXIM 1SYR TAN
Document
s 682500 0 0
produced/
Certificat 45d Other Charges 46 Customs value
0 682500
Type Tax Base Rate Amount MP
2801/ Export Duty 682,500.00 0 0.00 A
Total Tax due for this item : 0.00
47
Calculation
of taxes
2 of 2
