Port Code SB No SB Date

INDIAN CUSTOMS EDI SYSTEM INJNR6 6816278 17-DEC-21

CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br AASCA5509M 0
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 27AASCA5509M1Z3 GSN
GOVERNMENT OF INDIA CB CODE AAIFE0189NCH001
TYPE INV ITEM CONT
Nos 1 1 1
ICD JANORI, JANORI DANDORI DIST: NASIK PIN-422207 PKG 3350 G.WT KGS 15075 * SB22171220211728

PART - I - SHIPPING BILL SUMMARY

1.MODE 2.ASSESS 3.EXMN 4.JOBBING 5.MEIS 6.DBK 7.RODTP 8.DEEC/DFIA 9.DFRC 10.RE-EXP 11.LUT
STATUS

LAND N Y N Y Y Y N Y N
A

12.PORT OF LOADING INJNR6 (Nashik-Janori ICD) 13.COUNTRY OF FINALDESTINATION UNITED ARAB EMIRATES
14.STATE OF ORIGIN MAHARASHTRA 15.PORT OF FINAL DESTINATION AEJEA (Jebel Ali)

PY
16.PORT OF DISCHARGEAEJEA (Jebel Ali) 17.COUNTRY OF DISCHARGE UNITED ARAB EMIRATES
1.EXPORTER'S NAME & ADDRESS 7.CONSIGNEE NAME & ADDRESS
AGRIMO OVERSEAS PRIVATE LIMITED FIDELIS FOODSTUFF TRADING LLC
B DECLARAN

NEELKANTH PRERNA NO 3,FLAT NO. B-5 511,SULTAN BUSINESS CENTER OUD METH
DETAILS

,KARVE ROAD A,P.O.BOX 242567, DUBAI Dubai

CO
DOMBIWALI,MAHARASHTRA 2.Type Private AE
3. AD CODE: 0510200 8. GSTIN / TYPE 27AASCA5509M1Z3 GSN
4.RBI WAIVER NO.& DT 9.FOREX BANK A/C NO. 50XXXXXXXXX355
5.CB NAME EICON IMPEX LLP 10.DBK BANK A/C NO. 50XXXXXXXXX355
6.AEO 11. IFSC NO. HDFC0000175
1.FOB VALUE 2.FREIGHT 3.INSURANC 4.DISCOU 5.COM 1.DBK CLAIM 2. IGST AMT 3.CESS AMT
SUMMA
E MANIFEST C.VALU

EX.PR.
807729.98 134301 755 0 0 1212

D.
6.DEDUCTIONS 7.P/C 8.DUTY 9.CESS 4.IGST VALUE 5.RODTEP AMT 6.ROSCTL AMT
RT
0 0 16155 0
1.MAWB NO. 2.MAWB DT 3.HAWB NO. 4.HAWB DT N.O.C. 1.SNO 2.INV NO. 3. INV AMT. 4.CURRENC
DETAILS

F.INVOICE
1 0004 12495.5 USD
4. CIN NO. 5. CIN DT. 6. CIN SITE ID SUMMARY
21PCEG1217431835600 17-DEC-21 INJNR6
PO

1.CONTAINER 2.SEAL 3.DATE 4.S No 1SR.NO 2.CHALLAN NO 3.PAYMT DT 4.AMOUNT

CHALLAN DETAILS

CICU8204080 026759 17-DEC-21 1

G. EQUIPMENT
DETAILS

EX

H
T

1.SEAL TYPE 2.NATURE OF CARGO 3.NO. OF PACKETS 4.NO. OF CONTAINERS 5.LOOSE PACKETS
I. ANNEX
DETAILS

WAREHOUSE SEALED CONTAINERISED 3350 1 0

LE

6.MARKS & NUMBERS AS PER INV. We intend to claim benefit under RoDTEP scheme as applicable.

1.EVENT 2.DATE 3.TIME 4.LEO NO. 1/9

J.PROCESS

5.Submission 17-DEC-21 14:22 6.LEO Date. 17-DEC-21

DETAILS

5.Assessment 17-DEC-21 16:50 8.BRC Realisation Date 30-SEP-22

7.Examination 17-DEC-21 17:10
9.LEO 17-DEC-21 17:28

Signature Not Verified

Digitally signed by DS CENTRAL BOARD
OF INDIRECT TAXES AND CUSTOMS 04
Date: 2021.12.17 17:29:49 IST
Reason: CUSTOMS
Location: INDIA
Glossary
A: ASSESS - Assessed, EXMN - Examined, MEIS - Merchantise Export Incentive Scheme, DBK - Drawback, ROSL - Rebate of State Levies,
DEEC - Duty Exemption Entitlement Certificate, DFRC - Duty Free Replenishment Certificate,LUT - Letter of Under Taking. B: CB - Customs Broker
AD Authoized Dealer , AEO - Authorized Economic Operator, UCR - Unique Customs Reference C: DISCOU - Discount, COM - Commission,
P/C Packing Charges,D: EX. PR.- Export Promotions E: MAWB / HAWB - Master / House Airway Bill Number J:BRC- Bank Realisation Certificate

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Page 1 Of 5
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INJNR6 6816278 17-DEC-21
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br AASCA5509M 0
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 27AASCA5509M1Z3 GSN
GOVERNMENT OF INDIA CB CODE AAIFE0189NCH001
TYPE INV ITEM CONT
Nos 1 1 1
ICD JANORI, JANORI DANDORI DIST: NASIK PIN-422207 PKG 3350 G.WT KGS 15075 * SB22171220211728

PART - II - INVOICE DETAILS

1.S.No 2.INVOICE No. & Dt. 3.P.O.No. & Dt. 4.LoC No. & Dt 5.Contract No.&Dt 6.AD code 7.INVTERM
REF
A.

1 0004 17/12/2021 0510200 CIF

1.EXPORTER'S NAME & ADDRESS 2.BUYER'S NAME & ADDRESS
AGRIMO OVERSEAS PRIVATE LIMITED FIDELIS FOODSTUFF TRADING LLC

Y
NEELKANTH PRERNA NO 3,FLAT NO. B-5 511,SULTAN BUSINESS CENTER OUD METH
B. TRANSACTION

,KARVE ROAD A,P.O.BOX 242567, DUBAI Dubai

PARTIES

400602

OP
3.THIRD PARTY NAME & ADDRESS 4.BUYER AEO STATUS

1.INVOICE VALUE

TC
2.FOB VALUE 3FREIGHT 4.INSURANCE5DISCOUNT6.COMMISON 7.DEDUCT 8.P/C 9.EXCHANGE RATE
C.VAL
DTLS

12495.5 10705.5 1780 10 0 0 0 1 USD INR 75.45

USD USD USD USD
1.ItemSNo 2.HS CD 3.DESCRIPTION 4.QUANTITY 5.UQC 6.RATE 7.VALUE(F/C)
1 07096010 INDIAN FRESH GREEN CHILLI (EACH BOX 4.5 ) 3350 NOS 3.73 12495.5
OR
XP
TE
D. ITEM DETAILS

LE

Glossary
A: Ref - Reference P.O. - Purchase Order, LoC - Letter of Credit, AD - Authorised Dealer C: VAL DTLS - Valuation Details
FOB - Freight On Board, DEDUCT - Deduction , P/C - Packing Charge D: HS CD - Harmonized System Code, UQC - Unit Quantity Code

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Page 2 Of 5
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INJNR6 6816278 17-DEC-21
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br AASCA5509M 0
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 27AASCA5509M1Z3 GSN
GOVERNMENT OF INDIA CB CODE AAIFE0189NCH001
TYPE INV ITEM CONT
Nos 1 1 1
ICD JANORI, JANORI DANDORI DIST: NASIK PIN-422207 PKG 3350 G.WT KGS 15075 * SB22171220211728

PART - III - ITEM DETAILS

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 1 07096010 INDIAN FRESH GREEN CHILLI 3350 NOS 3.73 12495.5 807729.98 265.22
(EACH BOX 4.5 )
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y NA 19

PY
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 12730 KGS MAHARASHTRA MUMBAI
24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM
NCPTI 0 INR FSH100 Y Yes N

CO
RT
PO
INVOICE (1/1)

T EX
LE

GLOSSARY
FOB - Freight On Board, HS CD Harmonized System Code, UQC - Unit Quantity Code, PMV - Present Market Value, CESAM - Cess Amount
IGSTSTA - IGST Payment Status, VAL - IGST Value, PAID - IGST Amount Paid, SCHCOD - Scheme Code, SQC MSR - Standard Quantity
Measurement, comp - compensatory, PT Abroad - Preferential treatment Availed Abroad

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Page 3 Of 5
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INJNR6 6816278 17-DEC-21
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br AASCA5509M 0
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 27AASCA5509M1Z3 GSN
GOVERNMENT OF INDIA CB CODE AAIFE0189NCH001
TYPE INV ITEM CONT
Nos 1 1 1
ICD JANORI, JANORI DANDORI DIST: NASIK PIN-422207 PKG 3350 G.WT KGS 15075 * SB22171220211728

PART - IV - EXPORT SCHEME DETAILS

A. DRAWBACK & ROSL CLAIM

1.INV SNO 2.ITEM SNO 3.DBK SNO. 4.QTY/WT 5.VALUE 6.RATE 7.DBK AMT 8.STALEV 9.CENLEV 10.ROSCTL AMT
1 1 0709B 3350 807729.98 .15 1211.59 0 0 0
B. AA / DFIA LICENCE DETAILS
1.INV SNO 2.ITEM SNO 3.LICENCE NO 4.DESCN OF EXPORT ITEM 5.EXP SNO 6.EXPQTY 7.UQC 8.FOB VALUE

Y
9.SION 10.DESCN OF IMPORT ITEM 11IMP SNO 12IMPQT 13.UQC 14.INDIG / IMP

OP
C. JOBBING DETAILS
1.BE NO 2.BE DATE 3.PORT CODE 4.DESCN OF IMPORTED GOODS 5.QTY IMP 6.QTY USED

D. SINGLE WINDOW DECLARATION

1.INVSN 2.ITMSN
1 1
3.INFO
ORC STO
TC
4.QUALIFIER
27
5.INFO CD 6.INFO TEXT 7.INFO MSR 8.UQC

1 1 ORC DOO 482

1 1 CHR SQC 12730 KGS
1 1 ORC EPT NCPTI
1 1 DTY GCESS 0 INR
OTHER ADDITIONAL INFORMATION

1 1 DTY RDT RODTEPY Claimed 12730 KGS

OR

E. SINGLE WINDOW DECLARATION - CONSTITUENTS

1.INVSN2.ITMSNO 3.C SNO 4.NAME 5.CODE 6.PERCENTAGE 7.YIELD PCT 8.ING

F. SINGLE WINDOW DECLARATION - CONTROL

1.INVSN2.ITMSNO 3.CONTROL TYPE 4.LOCATION 5.ST DT 6.END DT 7.RES CD 8.RES TEXT
XP

G.SUPPORTING DOCUMENTS
1.INVSN2.ITMSNO 3 DOCTYPCD 4. ICEGATE ID 5. IRN 6.PARTY CD 7.ISSUE PLA 8.ISS DT 9.EXP DT
0 0 934000 EICONLLP 2021121700051503 MAHARASHTR17-DEC-21
TE

0 0 003001 EICONLLP 2021082500084867 MAHARASHTR25-AUG-21

1 0 380000 EICONLLP 2021121700051504 MAHARASHTR17-DEC-21
H.INVOICE DETAILS
1.SNO 2.INVOICE NO 3.INVOICE AMOUNT 4.CURRENCY
1 0004 12495.5 USD
I.CONTAINER DETAILS
LE

1.SNO 2.CONTAINER 3.SEAL 4.DATE

1 CICU8204080 026759 17-DEC-21
J.AR4 DETAILS
1.INVSN 2.ITMSN 3.AR4 NUMBER 4.AR4 DATE 5.COMMISSIONERATE 6.DIVISION 7.RANGE

K. THIRD PARTY DETAILS

1.INVSN 2.ITMSN 3.IEC 4. EXPORTER NAME 5. ADDRESS 6.GSTN ID AND TYPE

L. ITEM MANUFACTURER/PRODUCER/GROWER DETAILS

1.INVSN2.ITMSN 3.TYPE 4.MANUFACT CD 5.SOURCE STATE 6.TRANS CY 7.ADDRESS

M. RODTEP DETAILS
1.INVSN2.ITMSN 3. QUANTITY 4. UQC 5. NO. OF UNITS 6. VALUE
1 1 12730 KGS 1 16155

Glossary
INVSN - Invoice Serial Number ITMSN - Item Serial Number A: DBK - Drawback, ROSL - Rebate of State Levies, B: DFIA - Duty Free Import
Authorization, EXP - Export , IMP - Import , UQC-Unit Quanity CodeFOB - Freight On Board D: INFO - Information CD - Code MSR - Measuremen
E: ING - Ingredient F : RES CD - Result Code, RES TXT - Result Text ST DT -Start Date G: IRN - Image Reference Number CD - Code PLA - Pla

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Page 4 Of 5
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INJNR6 6816278 17-DEC-21
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br AASCA5509M 0
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 27AASCA5509M1Z3 GSN
GOVERNMENT OF INDIA CB CODE AAIFE0189NCH001
TYPE INV ITEM CONT
Nos 1 1 1
ICD JANORI, JANORI DANDORI DIST: NASIK PIN-422207 PKG 3350 G.WT KGS 15075 * SB22171220211728

PART - V - DECLARATIONS

Y
OP
TC
A. DECLARATION STATEMENT

OR
XP
TE
LE
B. AUTHORIZED
SIGNATORY

DATE AUTHORIZED SIGNATORY CHA NAME :AAIFE0189NCH001

PLACE

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Page 5 Of 5