‫‪United Arab Emirates‬‬ ‫ﺩﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫*‪*20240302087666‬‬
‫‪PORT TYPE‬‬ ‫‪ 4‬ﻧﻮﻉ ﺍﻟﻤﻨﻔﺬ‬ ‫‪DEC TYPE‬‬ ‫‪ 2 DEC NO‬ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ ‪ 3 DEC DATE‬ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫‪ 1‬ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬
‫‪Customs Declaration‬‬ ‫ﺑﺮﻱ‪ /‬ﺟﻤﺮﻙ ﺍﻟﻐﻮﻳﻔﺎﺕ‬ ‫ﺗﺼﺪﻳﺮ ‪Export‬‬ ‫‪03-06-2024‬‬ ‫‪20240302087666‬‬ ‫ﺑﻴﺎﻥ ﺟﻤﺮﻛﻲ‬
‫‪NET WEIGHT‬‬ ‫‪ 7 IMPORTER \ EXPORTER‬ﺍﻟﻮﺯﻥ ﺍﻟﺼﺎﻓﻲ‬ ‫‪ 6 DELIVERY ORDER NO.‬ﺍﻟﻤﺴﺘﻮﺭﺩ‪ /‬ﺍﻟﻤﺼﺪﺭ‬ ‫‪ 5‬ﺭﻗﻢ ﺇﺫﻥ ﺍﻟﺘﺴﻠﻴﻢ‬
‫‪9985 Kgs‬‬ ‫ﺑﺎﻙ ﺗﻮ ﻧﻴﺘﺸﺮ ﻟﻠﺼﻨﺎﻋﺎﺕ ﺫ ﻡ ﻡ ‪1480516‬‬ ‫‪24659871 03-06-2024 1‬‬

‫‪GROSS WEIGHT‬‬ ‫‪ 10 INTERCESSOR CO.‬ﺍﻟﻮﺯﻥ ﺍﻟﻘﺎﺋﻢ‬ ‫‪ 9 CARRIER'S\CAPTAIN\DRIVER‬ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﺳﻴﻄﺔ‬ ‫‪ 8‬ﺍﻟﻨﺎﻗﻠﺔ‪/‬ﺍﻟﻘﺒﻄﺎﻥ‪/‬ﺍﻟﺴﺎﺋﻖ‬

‫‪9985 Kgs‬‬ ‫ﺑﻮﺍﺳﻄﺔ ﺍﻟﺒﺮ ‪A91‬‬ ‫ﻣﺤﻤﺪ ﺍﻣﻴﻦ ﻣﺤﻤﺪ ﺭﻳﺎﺳﺖ ﻋﻠﻲ‪/‬ﺑﺎﻛﺴﺘﺎﻥ‬
‫ﻻﺳﺘﻌﻤﺎﻻﺕ ﻭﻛﻴﻞ ﺍﻟﻨﺎﻗﻠﺔ‬

‫‪MEASUREMENT‬‬ ‫ﺍﻟﻘﻴﺎﺱ‬ ‫‪13 COMMERCIAL REG No.‬‬ ‫‪ 12 CARRIER'S NAME‬ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ ‫‪ 11‬ﺇﺳﻢ ﺍﻟﻨﺎﻗﻠﺔ‬
‫‪0‬‬ ‫ﻣﺆﺳﺴﺔ ﺍﻟﺨﻠﻴﺞ ﻟﻠﺸﺤﻦ ﻭﺍﻟﻘﻤﺴﻴﻮﻥ ﻭﺗﺨﻠﻴﺺ ﺍﻝ ‪C002‬‬ ‫ﺩﺑﻲ‪/‬ﻣﺎﻥ ﺗﺮﻳﻼ‪68201/‬‬
‫‪NO.OF PACKAGES‬‬ ‫ﺍﻟﻤﺼﺪﺭ‪/‬ﺍﻟﻤﺼﺪﺭ ﺇﻟﻴﻪ ‪ 16 EXPORTER / EXPORTER TO‬ﻋﺪﺩ ﺍﻟﻄﺮﻭﺩ‬ ‫‪15 VOYAGE/ FLIGHT No‬‬ ‫ﺭﻗﻢ ﺍﻟﺮﺣﻠﺔ‬ ‫‪14‬‬
‫‪1100 CTN‬‬ ‫‪ECOMART INTERNATIONAL TRADING LLC‬‬ ‫‪68201 03-06-2024 18:48‬‬
‫‪MARKS & NUMBERS‬‬ ‫‪ 19 PORT OF LOADING‬ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻷﺭﻗﺎﻡ‬ ‫ﻣﻴﻨﺎﺀ ﺍﻟﺸﺤﻦ‬ ‫‪18 B\L-AWB No.\MANIF.‬‬ ‫‪ 17‬ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ‪/‬ﺍﻟﻤﻨﺎﻓﺴﺖ‬
‫‪CARRIER'S AGENT USE‬‬

‫‪/‬ﺷﻬﺎﺩﺓ ﻣﻨﺸﺎﺀ ‪333328946‬‬ ‫ﺟﻤﺮﻙ ﺍﻟﻐﻮﻳﻔﺎﺕ‬ ‫‪INV NO/BTNUMQ/1171/2024‬‬

‫ﻗﻄﺮ ﻣﻨﻔﺬ ﺳﻠﻮﻱ‬ ‫ﻭﺭﻕ ﺑﻨﻲ‪/‬ﺻﻨﺪﻭﻕ ﻭﺟﺒﺔ ﻛﺮﺍﻓﺖ ﻣﻊ ﻧﺎﻓﺬﺓ‬
‫‪PORT OF DISCHARGE‬‬ ‫‪ 20‬ﻣﻴﻨﺎﺀ ﺍﻟﺘﻔﺮﻳﻎ‬ ‫ﻋﻠﻮﻳﺔ‪/‬ﻛﻮﺏ ﺣﺴﺎﺀ ﻭﺭﻗﻲ ﺃﺑﻴﺾ‪/‬ﻛﻮﺏ ﺣﺴﺎﺀ ﻓﻠﻔﻞ‬
‫‪QAT‬‬ ‫‪/‬ﺃﺑﻴﺾ‬
‫ﻛﻮﺏ ﻗﻬﻮﺓ ﺃﺑﻴﺾ ﺑﺠﺪﺍﺭ ﻣﺰﺩﻭﺝ‪/‬ﻏﻄﺎﺀ ﺑﻼﺳﺘﻴﻜﻲ‬
‫‪DESTINATION‬‬ ‫‪ 21‬ﺟﻬﺔ ﺍﻟﻤﻘﺼﺪ‬ ‫‪/‬ﺃﺳﻮﺩ‪/‬ﻛﻮﺏ ﻗﻬﻮﺓ ﺃﺳﻮﺩ ﺑﺠﺪﺍﺭ ﻣﺰﺩﻭﺝ‬
‫ﻗﻄﺮ‪QAT/‬‬

‫ﺍﺟﻤﺎﻟﻲ ﺍﻟﺮﺳﻮﻡ‬ ‫‪31‬‬ ‫ﻧﻮﻉ‬ ‫‪30‬‬ ‫‪29‬‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻟﻤﺤﻠﻴﺔ‬ ‫‪28‬‬ ‫ﺍﻟﻌﻤﻠﺔ ‪CURRENCY‬‬ ‫‪25‬‬ ‫‪24‬‬ ‫‪22‬‬
‫ﺍﻻﻳﺮﺍﺩ‬ ‫ﻭﺻﻒ ﺍﻟﺒﻀﺎﻋﺔ‬ ‫‪23‬‬ ‫ﺑﻨﺪ ﺍﻟﺘﻌﺮﻓﺔ‬
‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻷﺟﻨﺒﻴﺔ‬ ‫ﺑﻠﺪ ﺍﻟﻤﻨﺸﺄ‬ ‫‪GOODS DESCRIPTION‬‬
‫‪TOTAL DUTY‬‬ ‫ﻓﺌﺔ ﺍﻟﺮﺳﻢ‬ ‫‪CIF LOCAL VALUE‬‬
‫‪INCOME‬‬ ‫ﺍﻟﺴﻌﺮ‬ ‫‪ 26‬ﺍﻟﻨﻮﻉ ‪27‬‬ ‫‪H.S. CODE‬‬
‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪TYPE‬‬ ‫‪D.RATE‬‬ ‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪VALUE‬‬ ‫‪FOREIGN VALUE‬‬ ‫‪ORIGIN‬‬
‫‪TYPE‬‬

‫‪0‬‬ ‫‪0‬‬ ‫‪12800‬‬ ‫‪1 DHS‬‬ ‫‪12800‬‬ ‫‪UAE‬‬ ‫ﺃﻛﻴﺎﺱ ﺃﺧﺮ‪ ،‬ﺑﻤﺎ ﻓﻴﻬﺎ ﺍﻟﻤﺨﺎﺭﻳﻂ‬ ‫‪48194000‬‬ ‫‪1‬‬
‫ﻹﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﻤﺴﺘﻮﺭﺩ ﺃ‬

‫‪0‬‬ ‫‪0‬‬ ‫‪16900‬‬ ‫‪1 DHS‬‬ ‫‪16900‬‬ ‫‪UAE‬‬ ‫ﺃﻛﻴﺎﺱ ﺃﺧﺮ‪ ،‬ﺑﻤﺎ ﻓﻴﻬﺎ ﺍﻟﻤﺨﺎﺭﻳﻂ‬ ‫‪48194000‬‬ ‫‪2‬‬
‫‪0‬‬ ‫‪0‬‬ ‫‪4100‬‬ ‫‪1 DHS‬‬ ‫‪4100‬‬ ‫‪UAE‬‬ ‫‪- KRAFT MEAL BOX‬‬ ‫‪48236900‬‬ ‫‪3‬‬
‫‪0‬‬ ‫‪0‬‬ ‫‪3600‬‬ ‫‪1 DHS‬‬ ‫‪3600‬‬ ‫‪UAE‬‬ ‫‪- KRAFT MEAL BOX‬‬ ‫‪48236900‬‬ ‫‪4‬‬

‫‪0‬‬ ‫‪0‬‬ ‫‪1500‬‬ ‫‪1 DHS‬‬ ‫‪1500‬‬ ‫‪UAE‬‬ ‫‪- WHITE PAPER‬‬ ‫‪48236900‬‬ ‫‪5‬‬

‫‪EXEMPTION OF DUTY‬‬ ‫ﺍﻹﻋﻔﺎﺀﺍﺕ‬ ‫‪AIP‬‬ ‫‪ WEIGHT‬ﻡ‪.‬ﻡ‪.‬ﺿﺎﺭﺓ‬ ‫‪ ITEM‬ﺍﻟﻮﺯﻥ‬ ‫‪ PACKAGES‬ﺍﻟﺼﻨﻒ‬ ‫ﺍﻟﻄﺮﻭﺩ‬ ‫‪CUSTOMS RESTRICTIONS‬‬ ‫ﺍﻟﻘﻴﻮﺩ ﺍﻟﺠﻤﺮﻛﻴﺔ‬
‫‪ 44‬ﺍﻟﻤﺴﺘﻔﻴﺪ‬ ‫ﺍﻟﻤﺼﺪﺭ‬ ‫‪ 42‬ﺍﻟﺮﻣﺰ ‪43‬‬ ‫ﺍﻟﻘﺎﺋﻢ ‪ 37A‬ﺍﻟﻨﺸﺮﺓ ‪ 37B‬ﺍﻟﺮﺳﻢ‬ ‫‪37‬‬ ‫‪ 36‬ﺍﻟﺼﺎﻓﻲ‬ ‫‪35‬ﻭﺣﺪﺓ‬ ‫‪ 32‬ﺍﻟﻜﻤﻴﺔ ‪ 33‬ﺍﻟﻨﻮﻉ ‪ 34‬ﺍﻟﻜﻤﻴﺔ‬ ‫ﻣﺮﺟﻊ ﺍﻟﻔﺴﺢ‬ ‫‪41‬‬ ‫ﺍﻟﺠﻬﺔ‬ ‫‪40‬‬
‫‪IMPORTER OR BROKER USE‬‬

‫‪BENEFICARY‬‬ ‫‪SOURCES‬‬ ‫‪CODE‬‬ ‫‪Duty‬‬ ‫‪No.‬‬ ‫‪GROSS‬‬ ‫‪NET‬‬ ‫‪UNIT‬‬ ‫‪QTY‬‬ ‫‪TYPE‬‬ ‫‪QTY‬‬ ‫‪RELEASE REF‬‬ ‫‪AGENCY‬‬
‫‪1‬‬
‫‪2‬‬
‫‪3‬‬
‫‪4‬‬
‫‪5‬‬

‫‪ AED‬ﺩﺭﻫﻢ‬ ‫‪DUTY‬‬ ‫ﺍﻟﺮﺳﻮﻡ‬ ‫‪CLEARING AGENT‬‬ ‫‪ 38‬ﺍﻟﻤﺨﻠﺺ ﺍﻟﺠﻤﺮﻛﻲ‬ ‫‪INSPECTION‬‬ ‫ﺍﻟﻤﻌﺎﻳﻨﺔ‬

‫ﺍﻟﺮﺳﻮﻡ ﺍﻟﺠﻤﺮﻛﻴﺔ ‪TOTAL DUTY‬‬ ‫‪56‬‬ ‫ﻧﻴﺒﺎﺭﺍﺱ ﻛﻮﻧﻬﻴﺒﺎﺭﺍﻣﺒﺎﺕ ﻛﺎﻓﻴﻞ ﻛﺎ ‪CE011163‬‬ ‫‪REASONS FOR NOT RELEASING‬‬ ‫ﺍﺳﺒﺎﺏ ﻋﺪﻡ ﺍﻟﻔﺴﺢ‬‫‪45‬‬
‫‪0 VAT‬‬ ‫‪ 56A‬ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
‫‪LICENCE No.‬‬ ‫‪ 39‬ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬
‫‪0 EXCISE TAX‬‬ ‫‪ 56B‬ﺿﺮﻳﺒﺔ ﺍﻧﺘﻘﺎﺋﻴﺔ‬ ‫ﻣﺆﺳﺴﺔ ﺍﻟﺨﻠﻴﺞ ﻟﻠﺸﺤﻦ ﻭﺍﻟﻘﻤﺴﻴﻮﻥ ﻭﺗﺨﻠﻴﺺ ‪C002‬‬
‫‪0 HANDLING‬‬ ‫‪ 57‬ﺭﺳﻮﻡ ﺍﻟﻤﻨﺎﻭﻟﺔ‬ ‫ﺍﻟﺒﻀﺎﺋﻊ‬
‫‪0 STORAGE‬‬ ‫‪ 58‬ﺭﺳﻮﻡ ﺍﻻﺭﺿﻴﺎﺕ‬
‫ﻹﺳﺘﻌﻤﺎﻻﺕ ﺍﻟﺠﻤﺎﺭﻙ‬

‫‪270OTHER CHARGES‬‬ ‫‪ 59‬ﺭﺳﻮﻡ ﺍﺧﺮﻯ‬

‫‪TRANSIT‬‬ ‫ﺍﻟﺘﺮﺍﻧﺰﻳﺖ‬
‫‪DEFINITE‬‬ ‫‪270‬‬ ‫‪ 60‬ﻗﻄﻌﻲ‬ ‫‪ROUTE‬‬ ‫‪ 50‬ﺧﻂ ﺍﻟﺴﻴﺮ‬
‫ﺇﺟﻤﺎﻟﻲ‬
‫‪INSURED‬‬ ‫‪0‬‬ ‫‪ 61‬ﺗﺄﻣﻴﻦ‬ ‫‪INSPECTOR‬‬ ‫‪ 46‬ﺍﻟﻤﻌﺎﻳﻦ‬
‫ﺍﻟﺮﺳﻮﻡ‬
‫‪PAYMENT METHOD‬‬ ‫ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬ ‫‪62‬‬
‫‪EXIT PORT‬‬ ‫‪ 51 GROUP SUPERVISOR‬ﺟﻤﺮﻙ ﺍﻟﺨﺮﻭﺝ‬ ‫ﺭﺋﻴﺲ ﺍﻟﻤﺠﻤﻮﻋﺔ‬ ‫‪47‬‬
‫‪EXIT TRANSACTION NO.‬‬ ‫‪ 52‬ﻗﻴﺪ ﺍﻟﺨﺮﻭﺝ‬
‫‪NO.‬‬ ‫‪ 63‬ﺭﻗﻢ‬
‫‪CUSTOM'S USE‬‬

‫‪2036376497 CR‬‬
‫‪DATE‬‬ ‫‪03-06-2024 19:36‬‬ ‫‪ 64 DATE‬ﺗﺎﺭﻳﺦ‬ ‫ﺗﺎﺭﻳﺨﻪ‬
‫‪53 OTHER REMARKS‬‬ ‫ﻣﻼﺣﻈﺎﺕ ﺃﺧﺮﻯ‬ ‫‪48‬‬
‫‪BANK‬‬ ‫‪ 65 SECURITY OFFICER‬ﺑﻨﻚ‬ ‫‪ 54 CIF‬ﻣﻮﻇﻒ ﺃﻣﻦ‬ ‫‪64,900 Dhs‬‬
‫‪RECEIPT NO.‬‬ ‫ﺭﻗﻢ ﺍﻳﺼﺎﻝ‬ ‫‪66‬‬
‫ﺍﻟﺪﻓﻊ‬
‫‪DATE‬‬ ‫‪ 67 TRANSIT OFFICER‬ﺗﺎﺭﻳﺦ‬ ‫‪ 55 RELEASE DATE‬ﻣﻮﻇﻒ ﺗﺮﺍﻧﺰﻳﺖ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺴﺢ‬ ‫‪49‬‬
‫‪BANK‬‬ ‫‪ 68‬ﺑﻨﻚ‬ ‫‪03-06-2024 19:36‬‬
‫‪87666/2024‬‬ ‫‪Insp‬‬ ‫‪C002G‬‬ ‫‪C002G‬‬ ‫‪Pre-Clear Bill‬‬

‫*‪*24659871‬‬
 ‫‪United Arab Emirates‬‬ ‫ﺩﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫‪Customs Declaration‬‬ ‫‪PORT TYPE‬‬ ‫‪ 4‬ﻧﻮﻉ ﺍﻟﻤﻨﻔﺬ‬ ‫‪DEC TYPE‬‬ ‫‪ 3‬ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫‪DEC DATE‬‬ ‫‪ 2 DEC NO‬ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ‬ ‫‪ 1‬ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﺑﻴﺎﻥ ﺟﻤﺮﻛﻲ‬
‫ﺟﻤﺮﻙ ﺍﻟﻐﻮﻳﻔﺎﺕ‬ ‫ﺗﺼﺪﻳﺮ ‪Export‬‬ ‫‪03-06-2024‬‬ ‫‪20240302087666‬‬

‫ﻣﺤﻤﺪ ﺍﻣﻴﻦ ﻣﺤﻤﺪ ﺭﻳﺎﺳﺖ ﻋﻠﻲ‬ ‫ﺑﺎﻛﺴﺘﺎﻥ‬ ‫‪68201‬‬ ‫ﺩﺑﻲ‬ ‫ﻣﺎﻥ ﺗﺮﻳﻼ‬ ‫ﺍﻟﺸﺎﺣﻨﺎﺕ‪/‬ﺍﻟﺴﺎﺋﻘﻴﻦ‬

‫‪48236900‬‬ ‫‪- WHITE PAPER SOUP‬‬ ‫‪UAE‬‬ ‫‪3150‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪3150‬‬ ‫‪0‬‬ ‫‪50‬‬ ‫ﺑﻨﺪ ﺍﻟﺘﻌﺮﻓﺔ‬
‫‪48236900‬‬ ‫‪- KRAFT PEPER CUP‬‬ ‫‪UAE‬‬ ‫‪3000‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪3000‬‬ ‫‪0‬‬ ‫‪100‬‬
‫‪48236900‬‬ ‫‪- KRAFT PEPER CUP‬‬ ‫‪UAE‬‬ ‫‪6300‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪6300‬‬ ‫‪0‬‬ ‫‪100‬‬
‫‪48236900‬‬ ‫‪- DOUBLE WALL WHIT‬‬ ‫‪UAE‬‬ ‫‪2650‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪2650‬‬ ‫‪0‬‬ ‫‪50‬‬
‫‪39235000‬‬ ‫ـ ﺳﺪﺍﺩﺍﺕ ﻭﺃﻏﻄﻴﺔ ﻭﻛﺒﺴﻮﻝ‬ ‫‪UAE‬‬ ‫‪1025‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪1025‬‬ ‫‪0‬‬ ‫‪50‬‬
‫‪39235000‬‬ ‫ـ ﺳﺪﺍﺩﺍﺕ ﻭﺃﻏﻄﻴﺔ ﻭﻛﺒﺴﻮﻝ‬ ‫‪UAE‬‬ ‫‪2650‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪2650‬‬ ‫‪0‬‬ ‫‪50‬‬
‫‪39235000‬‬ ‫ـ ﺳﺪﺍﺩﺍﺕ ﻭﺃﻏﻄﻴﺔ ﻭﻛﺒﺴﻮﻝ‬ ‫‪UAE‬‬ ‫‪1025‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪1025‬‬ ‫‪0‬‬ ‫‪50‬‬
‫‪48236900‬‬ ‫‪- WALL BLACK‬‬ ‫‪UAE‬‬ ‫‪6200‬‬ ‫‪DHS‬‬ ‫‪1‬‬ ‫‪6200‬‬ ‫‪0‬‬ ‫‪100‬‬
‫‪/‬ﺷﻬﺎﺩﺓ ﻣﻨﺸﺎﺀ ‪333328946‬‬ ‫ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻻﺭﻗﺎﻡ‬
‫ﻗﻄﺮ ﻣﻨﻔﺬ ﺳﻠﻮﻱ‬

‫‪/‬ﻭﺭﻕ ﺑﻨﻲ‪/‬ﺻﻨﺪﻭﻕ ﻭﺟﺒﺔ ﻛﺮﺍﻓﺖ ﻣﻊ ﻧﺎﻓﺬﺓ ﻋﻠﻮﻳﺔ‪/‬ﻛﻮﺏ ﺣﺴﺎﺀ ﻭﺭﻗﻲ ﺃﺑﻴﺾ‪/‬ﻛﻮﺏ ﺣﺴﺎﺀ ﻓﻠﻔﻞ ﺃﺑﻴﺾ‬ ‫ﻭﺻﻒ ﺍﻟﺒﻀﺎﻋﺔ‬
‫‪/‬ﻛﻮﺏ ﻗﻬﻮﺓ ﺃﺑﻴﺾ ﺑﺠﺪﺍﺭ ﻣﺰﺩﻭﺝ‪/‬ﻏﻄﺎﺀ ﺑﻼﺳﺘﻴﻜﻲ ﺃﺳﻮﺩ‪/‬ﻛﻮﺏ ﻗﻬﻮﺓ ﺃﺳﻮﺩ ﺑﺠﺪﺍﺭ ﻣﺰﺩﻭﺝ‬

‫‪58741853‬‬ ‫ﺗﺼﺎﺭﻳﺢ ﺍﻟﺴﺎﺋﻖ‬

‫‪2036376497‬‬ ‫ﺭﻗﻢ ﺍﻹﺷﻌﺎﺭ‬
‫‪03-06-2024‬‬ ‫ﺗﺎﺭﻳﺨﻪ‬ ‫ﺇﺷﻌﺎﺭ ﻣﺪﻳﻦ‬ ‫ﺟﻤﺮﻙ ﺍﻟﻐﻮﻳﻔﺎﺕ‬
‫‪DEBIT NOTE‬‬
‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﻮﺭﺩ‬
‫ﻣﺆﺳﺴﺔ ﺍﻟﺨﻠﻴﺞ ﻟﻠﺸﺤﻦ ﻭﺍﻟﻘﻮﻣﺴﻴﻮﻥ ﻭﺗﺨﻠﻴﺺ ﺍﻟﺒﻀﺎﺋﻊ‪469253/‬‬

‫‪Amount‬‬ ‫ﺍﻟﻤﺒﻠﻎ‬
‫ﺩﺭﻫﻢ‬ ‫ﻓﻠﺲ‬
‫ﻣﺌﺘﺎﻥ ﻭ ﺳﺒﻌﻮﻥ ﺩﺭﻫﻢ ﻓﻘﻂ ﻻ ﻏﻴﺮ‬ ‫‪Dhs.‬‬ ‫‪Fils‬‬
‫‪270‬‬
‫‪C002G 03-06-2024 19:36‬‬ ‫‪Pre-Clear Debit‬‬
‫‪Due Date‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻹﺳﺘﺤﻘﺎﻕ‬ ‫‪PRECLEARANCE OPERATION‬‬

‫‪01-09-2024‬‬ ‫ﻣﺴﺆﻭﻝ ﺍﻹﻳﺮﺍﺩﺍﺕ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﻠﻢ‬

‫ﺍﻟﻤﺒﻠﻎ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫ﺍﻟﻤﺒﻠﻎ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬ ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬
‫‪270‬‬ ‫‪87666‬‬ ‫ﺗﺼﺪﻳﺮ‬