‫‪Sultanate of Oman‬‬ ‫ﺳﻠﻄﻨﺔ ﻋﻤﺎﻥ‬

‫‪Royal Oman Police‬‬ ‫ﺷﺮﻃﺔ ﻋﻤﺎﻥ ﺍﻟﺴﻠﻄﺎﻧﻴﺔ‬

‫‪Directorate General of Customs‬‬ ‫ﺍﻻﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻠﺠﻤﺎﺭﻙ‬

‫‪Page 1 of 2‬‬
‫‪PORT‬‬ ‫ﺍﻟﻤﻨﻔﺬ‬ ‫‪DEC TYPE‬‬ ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ ‫‪DEC‬‬ ‫ﺗﺎﺭﻳﺦ‬ ‫‪DEC NO.‬‬ ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬
‫‪Customs Declaration‬‬ ‫ﺑﻴﺎﻥ ﺍﻟﺠﻤﺮﻛﻲ‬
‫‪Wajajah Land Border‬‬ ‫‪Statistical Import‬‬ ‫‪17/05/2024‬‬ ‫‪DECIMP1705249529111‬‬
‫‪NET WEIGHT‬‬ ‫ﺍﻟﻮﺯﻥ ﺍﻟﺼﺎﻓﻲ‬ ‫‪IMPORTER / EXPORTER‬‬ ‫ﺍﻟﻤﺴﺘﻮﺭﺩ‪/‬ﺍﻟﻤﺼﺪﺭ‬ ‫‪DELIVERY ORDER NO.‬‬ ‫ﺭﻗﻢ ﺇﺫﻥ ﺍﻟﺘﺴﻠﻴﻢ‬
‫‪4,820.000‬‬ ‫ﺳﺎﻟﻢ ﺑﻦ ﺧﻠﻔﺎﻥ ﺑﻦ ﺳﻌﻴﺪ ﺍﻟﺮﺯﻳﻘﻲ‬ ‫‪-- NIL --‬‬

‫‪GROSS WEIGHT‬‬ ‫ﺍﻟﻮﺯﻥ ﺍﻟﻘﺎﺋﻢ‬ ‫‪INTERCESSOR CO.‬‬ ‫ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﺳﻴﻄﺔ‬ ‫‪CAR / CAPT. / DRIVER‬‬ ‫ﺍﻟﻨﺎﻗﻠﺔ‪/‬ﺍﻟﻘﺒﻄﺎﻥ‪/‬ﺍﻟﺴﺎﺋﻖ‬
‫‪4,820.000‬‬ ‫ﺍﻟﻮﺗﺪ ﻟﺸﺤﻦ ﻭﻧﻘﻞ ﺍﻟﺒﻀﺎﺋﻊ ﻭﺍﻟﺘﺨﻠﻴﺺ ﺍﻟﺠﻤﺮﻛﻲ‬

‫‪Website: www.customs.gov.om :‬‬

‫‪MEASUREMENT‬‬ ‫ﺍﻟﻘﻴﺎﺱ‬ ‫‪COMMERCIAL REG. NO.‬‬ ‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ ‫‪CARRIER'S NAME‬‬ ‫ﺍﺳﻢ ﺍﻟﻨﺎﻗﻠﺔ‬
‫‪KG‬‬

‫‪NO. OF PACKAGES‬‬ ‫ﻋﺪﺩ ﺍﻟﻄﺮﻭﺩ‬ ‫‪EXPORT TO‬‬ ‫ﺍﻟﻤﺼﺪﺭ ﺇﻟﻴﻪ‬ ‫‪VOYAGE / FLIGHT NO.‬‬ ‫ﺭﻗﻢ ﺍﻟﺮﺣﻠﺔ‬
‫‪CARRIER'S AGENT USE‬‬

‫‪TIN No.‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻀﺮﻳﺒﻲ‬

‫‪MARKS & NUMBERS‬‬ ‫ﺍﻟﻌﻼﻣﺎﺕ ﻭﺍﻷﺭﻗﺎﻡ‬ ‫‪B/L - AWB NO. / MANIF.‬‬ ‫ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ‪/‬ﺍﻟﻤﻨﺎﻓﺴﺖ‬

‫‪PORT OF LOADING‬‬ ‫ﻣﻴﻨﺎﺀ ﺍﻟﺸﺤﻦ‬

‫‪PORT OF DISCHARGE‬‬ ‫ﻣﻴﻨﺎﺀ ﺍﻟﺘﻔﺮﻳﻎ‬ ‫‪/‬‬

‫‪Wajajah Land Border‬‬

‫‪DESTINATION‬‬ ‫ﺟﻬﺔ ﺍﻟﻤﻘﺼﺪ‬

‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺮﺳﻮﻡ‬ ‫ﻓﺌﺔ ﺍﻟﺮﺳﻢ‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻟﻤﺤﻠﻴﺔ‬ ‫‪CURRENCY‬‬ ‫ﺍﻟﻌﻤﻠﺔ‬ ‫ﺍﻟﻘﻴﻤﺔ ﺑﺎﻟﻌﻤﻠﺔ ﺍﻻﺟﻨﺒﻴﺔ‬ ‫ﺑﻠﺪ‬ ‫ﻭﺻﻒ ﺍﻟﺒﻀﺎﻋﺔ‬ ‫ﺑﻨﺪ ﺍﻟﺘﻌﺮﻓﺔ‬
‫‪TOTAL DUTY‬‬ ‫‪DUTY‬‬ ‫‪CIF LOCAL VALUE‬‬ ‫ﺍﻟﺴﻌﺮ‬ ‫ﺍﻟﻨﻮﻉ‬ ‫‪CIF FOREIGN‬‬
‫‪ORIGIN‬‬ ‫‪GOODS DESCRIPTION‬‬ ‫‪H.S. CODE‬‬
‫‪OMR‬‬ ‫‪RATE‬‬ ‫‪OMR‬‬ ‫‪RATE‬‬ ‫‪TYPE‬‬ ‫‪VALUE‬‬
‫‪CONSIGNEE OR CLEARING‬‬

‫‪E-mail : info@customs.gov.om :‬‬

‫‪50.000‬‬ ‫‪5.000‬‬ ‫‪1,000.000‬‬ ‫‪1.000‬‬ ‫‪OMR‬‬ ‫‪1,000.000‬‬ ‫‪CN‬‬ ‫‪LVCB3RBB1HG100089‬‬ ‫‪87021000‬‬ ‫‪1‬‬

‫‪Total :‬‬ ‫‪1,000.000‬‬

‫‪AIP‬‬ ‫‪CUSTOMS RESTRICTIONS‬‬ ‫ﺍﻟﻘﻴﻮﺩ ﺍﻟﺠﻤﺮﻛﻴﺔ‬

‫ﺭﻣﺰ ﺍﻹﻋﻔﺎﺀﺍﺕ‬ ‫‪ WEIGHT‬ﻡ‪ .‬ﻡ‪ .‬ﺿﺎﺭﺓ‬ ‫‪ CLASSIFICATION‬ﺍﻟﻮﺯﻥ‬ ‫‪ PACKAGES‬ﺍﻟﺼﻨﻒ‬ ‫ﺍﻟﻄﺮﻭﺩ‬
‫ﺍﻟﺮﺳﻢ‬ ‫ﺍﻟﻨﺸﺮﺓ‬ ‫ﺍﻟﻘﺎﺋﻢ‬ ‫ﺍﻟﺼﺎﻓﻲ‬ ‫ﻭﺣﺪﺓ‬ ‫ﺍﻟﻜﻤﻴﺔ‬ ‫ﺍﻟﻨﻮﻉ‬ ‫ﺍﻟﻜﻤﻴﺔ‬ ‫ﻣﺮﺟﻊ ﺍﻟﻔﺴﺢ‬ ‫ﺍﻟﺠﻬﺔ‬
‫‪EXEMPTION OF DUTY CODE‬‬
‫‪Duty‬‬ ‫‪No‬‬ ‫‪GROSS‬‬ ‫‪NET‬‬ ‫‪UNIT‬‬ ‫‪QTY.‬‬ ‫‪TYPE‬‬ ‫‪QTY.‬‬ ‫‪RELEASE REF.‬‬ ‫‪AGENCY‬‬
‫‪4,820.000‬‬ ‫‪4,820.000‬‬ ‫‪XUN‬‬ ‫‪1.000‬‬ ‫‪Unit‬‬ ‫‪1.0‬‬
‫‪FRT‬‬ ‫‪INS‬‬
‫‪0.000‬‬ ‫‪0.000‬‬

‫‪OMR‬‬ ‫‪ DUTY‬ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬ ‫ﺍﻟﺮﺳﻮﻡ‬ ‫‪CLEARING AGENT‬‬ ‫ﺍﻟﻤﺨﻠﺺ ﺍﻟﺠﻤﺮﻛﻲ‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ ﺍﻟﻤﻮﺣﺪ‬
‫‪Unified Customs Code‬‬
‫‪50.000 CUSTOMS DUTY‬‬ ‫ﺍﻟﻀﺮﻳﺒﺔ‬ ‫ﻟﻠﻤﺴﺘﻮﺭﺩ‪/‬ﺍﻟﻤﺼﺪﺭ‬
‫‪52.500 VAT‬‬ ‫ﺍﻟﻮﺗﺪ ﻟﺸﺤﻦ ﻭﻧﻘﻞ ﺍﻟﺒﻀﺎﺋﻊ ﻭﺍﻟﺘﺨﻠﻴﺺ ﺍﻟﺠﻤﺮﻛﻲ‬
‫ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ‬
‫ﺍﻟﻤﻀﺎﻓﺔ‬
‫‪LICENCE NO.‬‬ ‫ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬ ‫‪0000000000000001933254OM‬‬
‫‪0.000 EXCISE TAX‬‬ ‫ﺍﻟﻀﺮﻳﺒﺔ ﺍﻻﻧﺘﻘﺎﺋﻴﺔ‬
‫‪Dumping Fee‬‬ ‫ﺭﺳﻢ ﻣﻤﺎﺭﺳﺎﺕ‬ ‫‪2022/34119‬‬
‫ﺿﺎﺭﺓ‬
‫‪HANDLING‬‬ ‫ﺭﺳﻮﻡ ﺍﻟﻤﻨﺎﻭﻟﺔ‬ ‫ﺭﻣﺰ ﺍﻟﻤﺸﻐﻞ ﺍﻻﻗﺘﺼﺎﺩﻱ ﺍﻟﻤﻌﺘﻤﺪ‬
‫‪GCC AEO Code‬‬
‫‪OTHER‬‬ ‫ﺃﺧﺮﻯ‬ ‫‪EXIT PORT‬‬ ‫ﺍﻟﺨﻠﻴﺠﻲ‬
‫ﺟﻤﺮﻙ ﺍﻟﺨﺮﻭﺝ‬
‫‪DEFINIT‬‬ ‫‪112.500‬‬ ‫ﻗﻄﻌﻰ‬ ‫ﺍﺟﻤﺎﻟﻰ‬
‫‪INSURED‬‬ ‫‪0.000‬‬ ‫ﺗﺄﻣﻴﻦ‬ ‫‪TOTAL FEE‬‬

‫‪PAYMENT‬‬ ‫ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬

‫‪CUSTOMS USE‬‬

‫‪GUARANTEE/CHEQUE‬‬ ‫ﺿﻤﺎﻥ‪/‬ﺷﻴﻚ‬
‫‪NO.‬‬ ‫ﺭﻗﻢ‬
‫‪Other Remarks‬‬ ‫ﻣﻼﺣﻈﺎﺕ ﺍﺧﺮﻯ‬

‫ﺭﻣﺰ ﺍﻻﺳﺘﺠﺎﺑﺔ ﺍﻟﺴﺮﻳﻌﺔ‬

‫‪DATE‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫‪QR CODE‬‬

‫‪BANK‬‬ ‫ﺑﻨﻚ‬
‫‪RECEIPT‬‬
‫‪DATE‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫‪BANK‬‬ ‫ﺑﻨﻚ‬

‫ﺗﺄﺷﻴﺮﺓ ﺟﻤﺮﻙ ﺑﻠﺪ ﺍﻟﻤﻘﺼﺪ ‪:‬‬ ‫ﺭﻗﻢ ﺍﻟﺴﻴﻞ ﺍﻟﺠﻤﺮﻛﻲ ‪:‬‬

‫‪I/We, Importer/Clearing Agent hereby declare that‬‬
‫‪all data and documents submitted are true and‬‬ ‫ﺃﻗﺮ ﺃﻧﺎ‪/‬ﻧﺤﻦ ﺍﻟﻤﺴﺘﻮﺭﺩ‪ /‬ﻭﻛﻴﻞ ﺍﻟﺘﺨﻠﻴﺺ ﺑﺄﻥ ﺍﻟﺒﻴﺎﻧﺎﺕ‬ ‫ﻧﺆﻛﺪ ﻭﺻﻮﻝ ﺍﻟﺒﻀﺎﻋﺔ ﺗﻔﺎﺻﻴﻠﻬﺎ ﺃﻋﻼﻩ‬ ‫ﻧﺸﻬﺪ ﺑﺨﺮﻭﺝ ﺍﻟﺒﻀﺎﻋﺔ ﺗﻔﺎﺻﻴﻠﻬﺎ ﺃﻋﻼﻩ‬
‫‪REMARKS‬‬

‫‪complete.‬‬ ‫ﻭﺍﻟﻤﺴﺘﻨﺪﺍﺕ ﺍﻟﻤﺮﻓﻘﺔ ﺻﺤﻴﺤﺔ ﻭﻛﺎﻣﻠﺔ ﻭﺳﻮﻑ ﺃﺗﺤﻤﻞ‪/‬‬ ‫ﺑﺠﻤﺮﻙ‪:‬‬ ‫ﺑﺠﻤﺮﻙ‪:‬‬

‫‪I/We will bear any legal responsibility if the above‬‬
‫‪informations are not true.‬‬ ‫ﻧﺘﺤﻤﻞ ﺃﻳﺔ ﻣﺴﺆﻭﻟﻴﺔ ﻗﺎﻧﻮﻧﻴﺔ ﻓﻲ ﺣﺎﻟﺔ ﺛﺒﻮﺕ ﻏﻴﺮ ﺫﻟﻚ‪.‬‬ ‫ﺑﺘﺎﺭﻳﺦ‪:‬‬ ‫ﺑﺘﺎﺭﻳﺦ‪:‬‬
‫ﺍﻟﺨﺘﻢ ﻭ ﺍﻟﺘﻮﻗﻴﻊ‬ ‫ﺍﻟﺨﺘﻢ ﻭ ﺍﻟﺘﻮﻗﻴﻊ‬
 Sultanate of Oman ‫ﺳﻠﻄﻨﺔ ﻋﻤﺎﻥ‬
Royal Oman Police
Directorate General of Customs
APPENDIX ‫ﺷﺮﻃﺔ ﻋﻤﺎﻥ ﺍﻟﺴﻠﻄﺎﻧﻴﺔ‬
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‫ﺍﻻﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻠﺠﻤﺎﺭﻙ‬

PORT ‫ﺍﻟﻤﻨﻔﺬ‬ DEC TYPE ‫ﻧﻮﻉ ﺍﻟﺒﻴﺎﻥ‬ DEC DATE ‫ﺗﺎﺭﻳﺦ ﺍﻟﺒﻴﺎﻥ‬ DEC NO. ‫ﺭﻗﻢ ﺍﻟﺒﻴﺎﻥ‬
Wajajah Land Border Statistical Import 17/05/2024 DECIMP1705249529111

CONVAYANCE DETAILS

S/No Gate Pass Number Plate Number Vehicle Plate Type Chassis Number Driver Name
‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ‬ ‫ﺭﻗﻢ ﺇﺫﻥ ﺍﻟﺒﻮﺍﺑﺔ‬ ‫ﺭﻗﻢ ﻟﻮﺣﺔ‬ ‫ﻧﻮﻉ ﻟﻮﺣﺔ ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺭﻗﻢ ﺍﻟﺸﺎﺻﻲ‬ ‫ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ‬

ITEM SUMMARY
Duty OMR CIF VALUE OMR COO HS CODE
GROSS NET UNIT QTY. DESCRIPITION SL. NO.
‫ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﺠﻤﺮﻛﻴﺔ‬ ‫ ﺑﺎﻟﺮﻳﺎﻝ‬CIF ‫ﺍﻟﻘﻴﻤﺔ‬ ‫ﺷﻬﺎﺩﺓ ﺑﻠﺪ‬ ‫ﺭﻣﺰ ﺍﻟﻨﻈﺎﻡ‬
‫ﺍﻟﻮﺯﻥ ﺍﻟﻘﺎﺋﻢ‬ ‫ﺍﻟﻮﺯﻥ ﺍﻟﺼﺎﻓﻲ‬ ‫ﻭﺣﺪﺓ‬ ‫ﺍﻟﻜﻤﻴﺔ‬ ‫ﺍﻟﻮﺻﻒ‬ ‫ﺍﻟﺘﺴﻠﺴﻞ‬
‫ﺑﺎﻟﺮﻳﺎﻝ ﺍﻟﻌﻤﺎﻧﻲ‬ ‫ﺍﻟﻌﻤﺎﻧﻲ‬ ‫ﺍﻟﻤﻨﺸﺄ‬ ‫ﺍﻟﻤﻨﺴﻖ‬

50.000 1000.000 4820 4820.0 XUN 1.0 CN LVCB3RBB1HG100089 87021000 1