NEGARA BRUNEI DARUSSALAM 05
ROYAL CUSTOMS AND EXCISE DEPARTMENT
DUTIABLE IMPORTS DECLARATION FORM FORM C.17
Date Generated: 23/12/2025 10.01 AM - Page 1 of 2
PROCEDURE FOR OFFICIAL USE
1. Customs Procedure Code 94. Declaration Registration No. 95. Approved Date
Import 05 DEC-05609-202512-1604520 23/12/2025
2. Previous Procedure Code 96. Manifest Registration No. 97. Payment Date (if
applicable)
3. Transport Mode Code 4. Clearance Station Code
Air A International Airport (Passenger) 609
Exporter/Consigner Importer/Consignee
5. Name: - 10. Name: ROSALINA PADAYHAG
6. Address 7. Registration No. 11. Address 12. Registration No.
- BRUNEI DARUSSALAM -
8. Tel No. 13. Tel No.
- -
9. Postal: - - 14. Postal:-
Transport Agent
20. Arrival Date : 23-12-2025 21. Containerised: No 15. Name: ATRIZ SERVICES (FA)
22. Vessel/Flight/Vehicle No. 23. Vessel Name: 16. Address 17. Registration No.
BI69MZ - NO.59, SPG 15-23, RPN KG PANDAN P30001681
24. BL/DO/AWB No. 25. HBL/HAWB No. KUALA BELAIT 18. Tel No.
UGWQ4P - 7456256
Brunei Darussalam 19. Postal: KA3131
26. Country of Shipment Code 27. Country of Destination Code
Philippines PH624 Brunei Darussalam BN096
28. Port of Loading Code 29. Port of Discharge Code
Manila 6240 International Airport 601
30. Place of Release: - 31. Place of Receipt: - 39. Issue / Expiry
Supporting Documents 37. Permit/License No. 38. Issued By Date
32. Exchange Rate 33. Previous Declaration No. .
PHP 0.02311 -
34. Nature of Transaction
-
35. Invoice No.
RECEIPT
36. Other No. 40. Letter No. 41. Letter Type 42. Letter Date
- - -
For Temporary Import
43. Type of Application 44. Granted Period (Months) 45. Est. Date of Export 46. Place of Exportation
- - -
47. Project Name 48. Project Date From 49. Project Date To
- -
For Transit
50. Mode of Transport: - 51. Means of Transport:
52. Office of Departure (1st Checkpoint) Code 53. Office of Final Destination (Last Checkpoint) Code
- - - -
54. Via 2nd Checkpoint Code 55. Via 3rd Checkpoint Code
- - - -
Security Deposit (For Transit and Temporary Import only)
56. Type of Deposit: - 57. Deposit Amount -
58. Bank Guarantee Amount (B$) 59. Bank Guarantee/Cheque No. 60. Bank Name Code
- - -
Goods
61. Total Gross Weight (Unit) 62. Total No. of Packages 63. Total Invoice Amount (B$) 64. Insurance (B$)
570 Kg 570 899.56 4.50
65. Freight Charges (B$) 66. Other Charges (B$) [Link]:FOB INV PHP38,925
134.93 0.00
Goods (Continuation) Declaration Registration No. DEC-05609-202512-1604520 Page 2 of 2
68. No. of 69. Country
71. HS Code 72. UOM 73. Quantity
Packages of Origin
SN 70. Goods Description / Permit Info (PI)
74. Shipping [Link]
76. CIF Value (B$) 77. Duty Rate 78. Duty Payable (B$)
Marks No.
125 PH BRACELET,BANGLES ASSTD 71171190 KGM 125.00
1
CEBU PACIFIC $83.41 15% $12.51
170 PH BAGS,BELTBAG ,SLING BAG ASSTD 42021190 UNT 170.00
2
CEBU PACIFIC $544.52 5% $27.23
55 PH ASST WALLET 42021190 KGM 55.00
3
CEBU PACIFIC $58.72 5% $2.94
220 PH WATCHES ASSTD 91109000 KGM 220.00
4
CEBU PACIFIC $352.34 10% $35.23
No. of Goods: 4 Total Declared Value (B$): $1,038.99 Total Duty (B$): $79.00
Total CIF for dutiable goods (B$): $1,038.99 Total CIF for non-dutiable goods (B$): $0.00
Declaration
All the particulars declared by me/ us are true and correct.
79. Name: FARAHANA HJ SENIN 81. IC Colour:
80. IC No: 00316197 83. Date: 23/12/2025
82. Designation: -
Note: In completing this declaration, units and codes should be in accordance with the Brunei Trade Classification that is currently
enforced. Penalty for making an untrue or incorrect declaration: up to 12 months imprisonment and B$40,000 fine.
FOR OFFICIAL USE
Payment
84. Actual Total Duty Payable (B$): $43.00 89. Total Excise Duty Payable (B$): $36.00
85. Warehouse Rent (B$): $0.00 90. Total WTO Valuation Deposit $0.00
86. Parcel Clearance (B$): $0.00 91. Deducted Amount (B$): $0.00
87. Other Charges (B$): $0.00 92. Total Amount Payable (B$): $79.00
88. Total Deposit Payable (B$): $0.00 93. Receipt No:
98. Payment Status: Paid 101. Mode of Payment:
99. Payment Amount (B$): $79.00 102. Bank Name:
100. Payment Date: 23/12/2025
Verification by Proper Officer of Customs
Name: SYSTEM
Designation: - Date: 23/12/2025
Department: Royal Customs and Excise Department
Approval by Proper Officer of Customs
Name: SYSTEM
Designation: - Date: 23/12/2025
Department Royal Customs and Excise Department