UPS Electronic Return Label: View/Print Label

1 Ensure that there are no other tracking labels attached to your shipment.

2 Customs Invoice - 3 copies of a completed customs invoice are required for shipments with a commercial
value being shipped to/from non-EU countries. Please insure the customs invoice contains address
information, product detail - including value, shipment date and your signature.

3 Collection and Drop-off

Daily Pick up customers may add return package(s) to their outbound shipments by having them
ready for the driver as usual.
Take this package to a UPS location or to arrange for a collection, call UPS at 800-PICK-UPS
(7425-877) www.ups.com/content/cl/es/index.jsx and select the Locations tab, then select location
type: UPS Drop box.

4 Fold the printed label at the dotted line. Place the label in a UPS Shipping Pouch. If you do not have a
pouch, affix the folded label using clear plastic shipping tape over the entire label. Take care not to cover
any seams or closures.

5 To acknowledge your acceptance of the original language of the agreement with UPS as stated on the
confirm payment page, and to authorize UPS to act as forwarding agent for export control and custom
purposes, sign and date here:

Signature Date

FOLD HERE
 Invoice Page 1
FROM
Tax ID/EIN/VAT No.: Waybill Number: 1ZY4395F8674607473
Shipment ID: 1ZY4395F8674607473

Contact Name: Hospital hernan henriquez aravena

Angelica Balboa
Manuel Montt 115, 7 piso
de temuco-Unidad de Invest.Clinica Date:
Invoice No: 1-1461895873
de Investigacion Clinica PO No: V116-003
TEMUCO 4781151 Terms of Sale (Incoterm): FCA
Reason for Export: Other

Chile
Phone: 56994743310

SHIP TO SOLD TO INFORMATION

Tax ID/VAT No.: Tax ID/VAT No.:
Contact Name: C3i Inc Contact Name:
C3i Shipping Same as Ship To
248 Armstrong Road

PITTSTON, PA 18640

United States
Phone: 5709705108 Phone:

Units U/M Description of Goods/Part No. Harm. Code C/T/O Unit Value Total Value

0000004 EA Medidata iPhone 8 w/ 8517130000 CN 245.00 980.00

assessories
Medidata iPhone 8 w/
assessories

Additional Comments: values for customs purpose only, no commercial transaction

Declaration Statement: Invoice Line Total: 980.00

I hereby certify that the information on this invoice is true and
correct and the contents and value of this shipment is as stated Discount/Rebate: 0.00
above. Invoice Sub-Total: 980.00
Freight: 0.00
Insurance: 0.00
Other (N/A): 0.00
Total Invoice Amount: 980.00
Total Number of Packages: 1 Currency: USD
Shipper Date Total Weight: 6.0 LBS
 Invoice Page 1
FROM
Tax ID/EIN/VAT No.: Waybill Number: 1ZY4395F8674607473
Shipment ID: 1ZY4395F8674607473

Contact Name: Hospital hernan henriquez aravena

Angelica Balboa
Manuel Montt 115, 7 piso
de temuco-Unidad de Invest.Clinica Date:
Invoice No: 1-1461895873
de Investigacion Clinica PO No: V116-003
TEMUCO 4781151 Terms of Sale (Incoterm): FCA
Reason for Export: Other

Chile
Phone: 56994743310

SHIP TO SOLD TO INFORMATION

Tax ID/VAT No.: Tax ID/VAT No.:
Contact Name: C3i Inc Contact Name:
C3i Shipping Same as Ship To
248 Armstrong Road

PITTSTON, PA 18640

United States
Phone: 5709705108 Phone:

Units U/M Description of Goods/Part No. Harm. Code C/T/O Unit Value Total Value

0000004 EA Medidata iPhone 8 w/ 8517130000 CN 245.00 980.00

assessories
Medidata iPhone 8 w/
assessories

Additional Comments: values for customs purpose only, no commercial transaction

Declaration Statement: Invoice Line Total: 980.00

I hereby certify that the information on this invoice is true and
correct and the contents and value of this shipment is as stated Discount/Rebate: 0.00
above. Invoice Sub-Total: 980.00
Freight: 0.00
Insurance: 0.00
Other (N/A): 0.00
Total Invoice Amount: 980.00
Total Number of Packages: 1 Currency: USD
Shipper Date Total Weight: 6.0 LBS
 Invoice Page 1
FROM
Tax ID/EIN/VAT No.: Waybill Number: 1ZY4395F8674607473
Shipment ID: 1ZY4395F8674607473

Contact Name: Hospital hernan henriquez aravena

Angelica Balboa
Manuel Montt 115, 7 piso
de temuco-Unidad de Invest.Clinica Date:
Invoice No: 1-1461895873
de Investigacion Clinica PO No: V116-003
TEMUCO 4781151 Terms of Sale (Incoterm): FCA
Reason for Export: Other

Chile
Phone: 56994743310

SHIP TO SOLD TO INFORMATION

Tax ID/VAT No.: Tax ID/VAT No.:
Contact Name: C3i Inc Contact Name:
C3i Shipping Same as Ship To
248 Armstrong Road

PITTSTON, PA 18640

United States
Phone: 5709705108 Phone:

Units U/M Description of Goods/Part No. Harm. Code C/T/O Unit Value Total Value

0000004 EA Medidata iPhone 8 w/ 8517130000 CN 245.00 980.00

assessories
Medidata iPhone 8 w/
assessories

Additional Comments: values for customs purpose only, no commercial transaction

Declaration Statement: Invoice Line Total: 980.00

I hereby certify that the information on this invoice is true and
correct and the contents and value of this shipment is as stated Discount/Rebate: 0.00
above. Invoice Sub-Total: 980.00
Freight: 0.00
Insurance: 0.00
Other (N/A): 0.00
Total Invoice Amount: 980.00
Total Number of Packages: 1 Currency: USD
Shipper Date Total Weight: 6.0 LBS
Documentation Instructions Instrucciones de documentación
Thank you for choosing UPS. Please review the following instructions Gracias por elegir UPS. Por favor, consulte las siguientes instrucciones
regarding the documentation that must accompany your shipment.
referentes a la documentación que debe acompañar su envío.
Provide the Correct Documentation Proporcione la documentación correcta

• Government regulations require documents that provide specific •Las regulaciones gubernamentales requieren documentos que
information about your international shipment.
proporcionen información específica sobre su envío internacional.
• Documentation regulations and requirements for individual commodities •Las regulaciones y los requisitos de la documentación para
vary from country to country. It is essential to review the commodity-
mercancías individuales varían según el país. Es esencial revisar la
specific documentation necessary for both the country of origin and the
country of destination. Depending on the commodity and its use, documentación específica de la mercancía necesaria tanto para el
accompanying documents may require special notations and licenses. país de origen como para el país de destino. Dependiendo de la
mercancía y su uso, la documentación adjunta puede requerir
licencias y notaciones especiales.
• The shipper also referred to as exporter of record, is responsible for •El remitente, también denominado exportador en registro, es
providing complete and accurate information for export manifesting and
responsable de proporcionar información completa y precisa en el
customs clearance in the destination country. It may be necessary to
contact the company or person who arranged for the shipment of goods manifiesto de exportación, y para efectos del despacho de aduanas
in order to verify the information and forms that must be submitted with en el país de destino. Pudiera ser necesario contactar a la empresa o
the shipment. persona que organizó el envío de mercancía con el fin de verificar la
información y los formularios que se deben presentar con el envío.
• High declared value shipments must be accompanied by UPS •Los envíos con valor declarado alto deben estar acompañados por
documentation that lists the package and instructions for preparation.
documentación de UPS que indique el paquete e instrucciones de
Please follow these instructions and present the completed
documentation to a UPS driver or UPS customer service representative. preparación. Por favor, siga estas instrucciones y presente la
documentación completa a un conductor de UPS o representante del
servicio al cliente de UPS.
Providing a Complete Invoice Proporcionar una factura completa

• The invoice information is used for customs clearance and the •La información de factura se utiliza para efectos del despacho de
assessment of any applicable duties or taxes charged by the destination
aduanas, y para la evaluación de cualquier derecho de aduana o
country.
impuestos aplicables que pueda cobrar el país de destino.
• Be sure to include the original invoice and two copies of the invoice with •Asegúrese de incluir la factura original y dos copias de la misma en
the shipment for proper processing.
el envío para procesamiento correcto.
• Review your documents and verify the accuracy of all fields. •Revise sus documentos y verifique la exactitud de la información de
todos los campos.
To ensure your shipment is processed properly, you must sign the Para asegurarse de que su envío se procese correctamente,
invoice.
debefirmar la factura.
International Shipping Assistance Asistencia para envíos internacionales

• Visit ups.com: •Visite ups.com:

o to download a commercial invoice or other international forms o para descargar una factura comercial u otros formularios
internacionales
o to find a drop-off location near you o para encontrar una ubicación de centros de envío cerca de usted

o to arrange a pickup o para programar una recolección

o for additional information on how to contact UPS o para obtener información adicional sobre cómo contactar a UPS

• For assistance from the company you are shipping to, contact them •Para obtener asistencia de la compañía a la cual está enviando los
directly.
artículos, contacte a dicha compañía directamente.
Note: Not all services may be available in your area. Nota: No todos los servicios pudieran estar a su disposición en su
área.