NIGERIA CUSTOMS SERVICE
DECLARATION FORM
2 Consignor/Exporter No 1 DECLARATION A. CLEARANCE OFFICE PTML
AES Office Code Manifest Number
INC IM 4
01TG B 39 2025
3 Forms 4 Loading Lists Registration number & date Assessment number & date
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1 1 18/05/2025
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5 Items 6 Tot. Pkgs. 7 Reference number Receipt number & date
1 1 HIGH 016
8 Consignee/Importer No 1086462213 9 Person responsible for financial settlement No 1086462213 10 Country of Last
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ADE-DUNTOYE ANDREW ADE-DUNTOYE ANDREW US Consign
NO 21 FASALI STREET, IKOTUN, LAGOS, Nigeria LAGOS NO 21 FASALI STREET, IKOTUN, LAGOS, Nigeria LAGOS 11 Trading
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NG Consign
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15 Country of dispatch/export 15 C. disp./exp. code 17 Country destin. code
UNITED STATES a US b a NG b
14 Declarant/Agent No 20297263-0001 16 Country of origin 17 Country of destination 13 Penalty
ALAPAKRISTI NIGERIA LIMITED UNITED STATES NIGERIA
7 BISHOP OLUBUNMI ODUFALE CLOSE SOEASY 20. Delivery Terms Business Activity
NG
CFR
18 Identity and nationality of means of transport at arrival 19 Ctr. 22 Currency and total amount invoiced 23 Exchange rate 24 Nature of
GRANDE DAKAR IT x USD 3,001.000 1598.2200 transaction
21 Identity and nationality of active means of transport crossing the border 28 Financial and banking data 24 Invoice Details
GRANDE DAKAR IT Bank Code Currency Amount
58 Guarantee Trust Bank Ex. Freight NGN 0.000
25 Mode of transport 26 Inland mode 27 Place of Discharge
Branch Terms of Payment
Insurance NGN 0.000
at the border of transport 152515 APAPA 05 PAYMEN
1 3 Lagos NG LOS
T
BURMA Other NGN 0.000
29 Office of entry/exit 30 Location of goods ROAD
In. Freight NGN 0.00
01TG | PTML TG004 | MILE II TERMINAL SHED IV B. A. number and date
Total NGN 0.000
31 Packages Marks & 32 Item 33 Commodity Code
and numbers 1 No 8703332000 00 0000 0000
description
of goods
Ctr.
No(s)
5TDDKRFH1GS290284
F
Number & kind of packages 34 Country of origin Code 35 Gross Mass (kg) 36
Preference
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1 U Unit (s) a b
IT 2,680.000
No
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Description of goods 42 a
1 USED TOYOTA HIGHLANDER 37 PROCEDURE 38 Net Mass (kg) 39 Quota
Ex. Freight 0.00
Used Vehicles, with diesel or semidiesel engine, of cylinder capacity 4100 846 2,680.000
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>2500cc Insurance 0.00
40 Summary declaration/Previous document / Way bill
Other Costs 0.00
S326903406
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In. Freight 0.00
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44 Additional License number Deducted Quantity Deducted Value 41 Supplementary units
B' 42 Item price 43 V.M.
Information/ U 1 3001
R
Code
Produced
documents Attached document codes A.I. Code 45 Adjustment
094 125 1.00000
46 Statistical Value
PAAR 4,796,258.220
47 Taxes & Type Duty/Tax Base Rate Amount MP 48 Account No 49 Identification of warehouse
D
duties DTY 4,796,258.220 20.000 959,251.640 Summary of Total Duties And Taxes
NAU 4,796,258.220 15.000 719,438.730
SUR 959,251.640 7.000 67,147.620 Amount
ETL 4,796,258.220 0.500 23,981.290 Total duties & taxes 2,262,275.090
VAT 6,566,077.500 7.500 492,455.810 Guarantee amount 0.000
Total fees 0.00
Other 0.00
Total 2,262,275.090 0 Total Payable 2,262,275.090
50 Declaration 48 Account No
I, ALAPAKRISTI NIGERIA LIMITED , the undersigned of ALAPAKRISTI NIGERIA LIMITED do hereby declare
that the information and particulars declared are true and complete and accept fully the condition and
requirements attaching to the use of CPC declared here in and hold myself liable for any inaccurate
information.
Signature Date & stamp Address
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52 Guarantee Code 53 Office of destination (and country)
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not valid for
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D CONTROL BY OFFICE OF DEPARTURE Stamp 54 Place and date:
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Result:
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Signature and name of declarant/representative
Seals affixed: Number:
ALAPAKRISTI NIGERIA LIMITED
Identity:
Time limit (date):
Signature:
PAGE 1 / 2
NIGERIA CUSTOMS SERVICE
DECLARATION FORM - List of Containers
1 DECLARATION [Link] OFFICE
PTML Manifest Number
IM 4
01TG B 39 2025
3 Forms 5 Items Registration number & date Assessment number & date
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1 1 18/05/2025
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# Container Reference Item No Type E/F Other characteristics
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1 5TDDKRFH1GS290284 NCVH 1/1 CR
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PAGE 2 / 2