GOVERNMENT OF NEPAL, MOF, DEPARTMENT OF CUSTOMS

A CUSTOMS OFFICE
BHANSAR PRAGYAPAN PATRA 1 DECLARATION FORM
BRT03
2 Exporter No. IM 4 Biratnagar Customs Office,
POLYCHEM ASIA CO. LTD, Customs Reference [Link].89
KOREA
3 Forms 4 CTDno M 19356 01/04/2026
1 1 1,096,30 Manifest
5 Items 6 Tot pack. 7 Declarant Reference number

1 1,840.00 2026 #1969

8 Importer No. 6100826540106NP 9 Invoice/Transport document No.

GENERAL INFORMATION SEGMENT

Rathi Hardware Pvt. Ltd. PCA-26001A DT 03/02/2026

Morang CTD NO:1096300
Biratnagar BL NO:A27GA00118 DT 11/02/2026

10 Cty f. dest 11 Trading 12 Value details 13 WHSDays

KR of KR cty. 474,529.81
281 15 Country of export 15 C.E. Code 17 C.D. Code
14 Declarant/Agent/Representative No.
Poddar Clearing Service Korea, Republic of a KR b a b
Biratnagar-16,Morang
Binod Kumar Poddar 16 Country of origin 17 Country of destination

Korea, Republic of
18 Flight or Vehicle Number 19 Ctr. 20 Delivery terms & Place

2TRUCK IN yes CFR KOLKATA,INDIA

21 More Vehicle number 22 Currency & total amount invoiced 23 Exch. rate 24 Nature of

NL01AC5955,NL01AE9169 USD 32,660.00 152.0400 transac.

25 Mode transport 26 Inland mode 27 Place of destination 28 Banking Information Bank Code 11026001
04 at border 04 Transport NPMRG MORANG Terms of payment 200 Under Letter of Credit (L/C)
29 Office of entry/exit 30 Location of goods PRABHU BANK LTD
BRT0 Biratnagar Customs OPEN...YARD BG No:
31 Packages Number & Packages. 32 Item 33 Commodity code(Harmonized Code)
and
Number 1 No 39041000 000
description
of goods of packages 34 Cty. orig. Code 35 Gross mass (kg) 36 Prefer.

and kind 1,840.00 BG a KR b 46,644.0000

Bag 37 PROCEDURE 38 Net mass (kg) 39 Quota
System H.S Poly(vinyl chloride), not mixed with other N substances, in
Description: 4000 000 46,000.0000
Declared Name: PVC LS-100 40 Summary declaration / Previous document S/L

| | 42 Item Price 43 V.M.

41 Supplementary units

44 Add. info Licence No [Link] [Link] KGM 46,000.0000 32,660.00 V001

Documents
Produced
456,968.81+0.00+17,561.00+0.00-0.00 A.I. Code 45 Adjustment

Certificates A.D. 100 103 1.0000

and autho- 46 Statistical value
rization
LC:00621P26008283 DT 27/01/2026 5,440,156.21
47 Calcul- Type Tax base Rate Amount MP 48 Deferred payment 49 Identification of warehouse
ation of
taxes ID 5,440,157.00 10.00 544,016.00 1
VAT 5,984,173.00 13.00 777,943.00 1 B ACCOUNTING DETAILS
CVF 2.00 1,500.00 3,000.00 1 CASH
Mode of payment

Assessment number / Date

Receipt number Date

Guarantee 0.00 NPR Date

Total fees 565.00 NPR

Cash Deposit 0.00 Total 1,324,959.00 1 Total declaration 1,325,524.00 NPR
50 Principal No. Signature C I/We hereby certify that the information contained in all
pages of this document submitted are true and correct and
I/we know that any untrue and discrepancy submitted would
be sufficient for legal section against me.

Sign. Date:

51 Intended Represented by Name: PRO. Binod Poddar

offices of Place and date Address:
transit and
country Clearance Through:
- N/A

52 Guarantee Code 53 Office of destination and country

not valid for

D CONTROL BY OFFICE OF DESTINATION 54 Place and date

Inspector's Name and Signature Stamp: Customs Officer Name and

Signature