Port Code BE No BE Date BE Type

INMAA4 2228906 23/05/2025 W

IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - I - BILL OF ENTRY SUMMARY

7.ADV BE 11.FIRST 12. PROV/

1.BE STATUS 2.MODE 3.DEF BE 4.KACHA 5.SEC 48 6.REIMP 8.ASSESS 9.EXAM 10.HSS
STATUS

(Y/N/P) CHECK FINAL

A.

FIRST COPY Air T N N N Y N N N N F

13.COUNTRY OF ORIGIN COSTA RICA 14.COUNTRY OF CONSIGNMENT UNITED STATES
15.PORT OF LOADING LA UNION 16.PORT OF SHIPMENT LA UNION
1.IMPORTER NAME & ADDRESS
DECLARANT

INDIA MEDTRONIC PRIVATE LIMITED

BLOCK 1, SURVEY NO. 389, 400/2A, 2C
B.

PUDUR MAIN ROAD, POONAMALLEE, KUTHA 2.CB NAME RELIANCE MARITIME AGENCIES

PY
TIRUVALLUR 3.AEO
600124 4.UCR
AD CODE 6430002
1.BCD 2.ACD 3.SWS 4.NCCD 5.ADD 6.CVD 7.IGST 8.G.CESS 18.TOT.ASS VAL
SUMMARY
C. DUTY

86.8 0 0 0 0 156 0 1157

9.SG 10.SAED 11.GSIA 12.TTA 13.HEALTH 14.TOTAL DUTY 15.INT 16.PNLTY 17.FINE 19.TOT. AMOUNT

CO
301 301

1.IGM NO 2.IGM DATE 3.INW DATE 4.GIGMNO 5.GIGMDT 6.MAWB NO 7.DATE 8.HAWB NO 9.DATE 10.PKG 11.GW
0 0 02357160994 18/05/2025 88132337586 18/05/2025 1 .5
D.MANIFEST
DETAILS

9
D
E. BOND DETAILS

1.BOND NO. 2.PORT 3.BOND CD 4.DEBT AMT 5.BG AMT 1.SR NO 2.CHALLAN NO 3.PAID ON 4.AMOUNT(Rs.)
F. PAYMENT

2002427806 INMAA4 WH 903 0

DETAILS
SE

1.WBE NO. 2.DATE 3.WBE SITE 4.WH CODE 1.S.NO 2.INVOICE NO 3.INV. AMT 4.CUR
INVOICE DETAILS - SUMMARY#
WH
G.

ES

MAA1U116 1 91095425 1157.1 INR

1.EVENT 2.DATE 3.TIME EXCHANGE RATE
H. PROCESSING

Submission 23-MAY-25 12:12 INR=INR

DETAILS

Assessment 23-MAY-25 12:14

Examination
S

OOC
I.
AS

1.SNO 2.LCL/ 3.TRUCK 4.SEAL 5.CONTAINER NUMBER

CONTAINER DETAILS *

FCL
OOC NO.
OOC DATE
J.

Signature Not Verified

Digitally signed by DS CENTRAL BOARD
OF INDIRECT TAXES AND CUSTOMS 08
Date: 2025.05.23 12:21:36 IST
Reason: CUSTOMS
Location: INDIA
GLOSSARY
A : DEF - Deferred Payment, REIMP - Reimport, ADV - Advance, P - Prior, HSS - HighSeaSale; B : CB - Customs Broker, AEO - Authorized
Economic Operator, UCR - Unique Customs Reference; D : GIGM - Gateway IGM; G : WBE - WareHouse BE; I : OOC - Out of Charge, # Refer Par
IV for full list of Invoices J : * Refer Part IV for full list of Containers, AP - Authorised Person

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 Port Code BE No BE Date BE Type
INMAA4 2228906 23/05/2025 W
IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - II - INVOICE & VALUATION DETAILS (Invoice 1 1 )

INVOICE

1.S.NO 2.INVOICE NO. & DT. 3.PURCHASE ORDER NO & DT 4.LC NO & DATE 5.CONTRACT NO & DATE
A.

1 91095425
15-MAY-25
1.BUYER'S NAME & ADDRESS 2.SELLER'S NAME & ADDRESS
INDIA MEDTRONIC PRIVATE LIMITED
TRANSACTING PARTIES

BLOCK 1, SURVEY NO. 389, 400/2A, 2C

PY
PUDUR MAIN ROAD, POONAMALLEE, KUTHA
TIRUVALLUR
600124
B.

3.SUPPLIER NAME & ADDRESS 4.THIRD PARTY NAME & ADDRESS

MEDTRONIC INTERNATIONAL TRADING PTE, LTD
50 PASIR PANJANG ROAD, 04-51
MAPLETREE BUSINESS CITY 117384

CO
SINGAPORE
SINGAPORE
5.AEO 6. AD CODE 6430002
SERVICES VALUATION

1.INV VALUE 2.FREIGHT 3.INSURANCE 4.HSS. 5.LOADING 6.COMMN 7.PAY TERMS 8.VALUATION METHOD
C.

1157.1 OTH Rule 4

14.Cur INR 9.RELTD 10.SVB CH 11.SVB NO 12.DATE 13LOA
15.Term CIF No
D. COST &

1.C&B 2.CoC 3.CoP 4.HND CHG 5.G&S 6.DOC. CH

ED

7.COO 8.R & LF 9.OTH COST 10.LD / ULD 11.WS 12.OTC 13.MISC CHARGE 14.ASS. VALUE
1157.1
1.S NO. 2.CTH 3.DESCRIPTION 4.UNIT PRICE 5.QUANTITY 6.UQC 7.AMOUNT
1 90189099 MATERIAL NUMBER : 00763000573690 578.550000 2.000000 NOS 1157.10
SERTER MMT-305QS PLUNGER BAG
SS

MDR
SE
ITEM DETAILS

AS
E.

GLOSSARY
A : LC - Letter of Credit; B : AD - Authorized Dealer; C : HSS - High Sea Sale; D : C&B Commission & Brokerage, CoC - Cost of Container,CoP - Co
of Packing, HND CHG - Handling Charges, G&S - Goods and Service input cost, DOC CH - Document Charges, CoO - Country of Origin Certificate,
R&LF - Royalty and Licence Fees, LD/ULD - Loading Unloading Charges, WS - Warranty Services, OTC - Other Costs, CTH - Customs Tariff Head,
UQC - Unit Quantity Code

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 Port Code BE No BE Date BE Type
INMAA4 2228906 23/05/2025 W
IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - III - DUTIES

1.INVSNO 2.ITEMSN 3.CTH 4.CETH 5.ITEM DESCRIPTION 6.FS 7.PQ 8.DC 9.WC 10.AQ
DETAILS

1 1 90189099 NOEXCISE MATERIAL NUMBER : 00763000573690 SERTER MMT- N N N N N

A. ITEM

305QS PLUNGER BAG MDR

11.UPI 12.COO 13.C.QTY 14.C.UQC 15.S.QTY 16.S.UQC 17.SCH 18.STND/PR 19.RSP 20.REIMP 21.PROV 22.END USE
578.55 CR 2 NOS 2 NOS S N N GNX200
23.PRODN24.CNTRL 25.QUALFR 26.CONTNT 27.STMNT 28.SUP DOCS 29.ASSESS VALUE 30. TOTAL DUTY
N N Y N N N 1157.1 300.9

PY
DUTY 1. BCD 2.ACD 3.SWS 4.SAD 5.IGST 6.G. CESS 7.ADD 8.CVD 9.SG 10.T. VALUE
Notn No. 050/2017 011/2018 001/2017 001/2017
B. ITEM
DUTY

Notn SNo. 563A 56C II218 56

Rate 7.5 0 12 0 0
Amount 86.8 0 156.2 0 0 0
Duty Fg 51.9 0 0

CO
DUTY 1.SP EXD 2.CHCESS 3.TTA 4.CESS 5.CAIDC 6.EAIDC 7.CUS EDC 8.CUS HEC 9.NCD 10.AGGR
C. OTHER

Notn No. 011/2021

DUTIES

Notn SNo. 17
Rate 5 0 0 0
Amount 57.86 0 0 0
Duty Fg 115.71 0
ED
SS
SE
AS

GLOSSARY
A : INVSNO - Invoice Sr. No., UPI - Unit Price Invoiced, C.Qty - Commercial Quantity, S.Qty - Standard Quantity, FS - Food Safety and Standards
Authority of India, PQ - Plant Quarantine, DC - Central Drugs Standard Control Organisation, WC - WildLife Crime Control Bureau , AQ - Animal
Quarantine and Certification Services, SCH - Scheme Code

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 Port Code BE No BE Date BE Type
INMAA4 2228906 23/05/2025 W
IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - IV - ADDITIONAL DETAILS

A. SVB DETAILS
1.INVSNO 2.ITMSNO 3.REF NO 4. REF DT 5. PRT CD 6.LAB 7.P/F 8.LOAD DATE 9.P/F

B. PREVIOUS BEs
1.INVSNO 2.ITMSNO 3. BE NO 4. BE DATE 5. PRT CD 6.UNITPRICE 7.CURRENCY CODE

C. RE-IMPORT AFTER EXPORT

1.INVSNO 2.ITMSNO 3.NOTN NO 4.SLNO 5.FRT 6.INS 7.DUTY 8.SB NO 9.SB DT 10.PORTCD 11.SINV 12.SITEMN

PY
D. ITEM MANUFACTURER/PRODUCER/GROWER DETAILS
1.INVSNO 2.ITMSNO 3.TYPE 4.MANUFACT CD 5.SOURCE CY 6.TRANS CY 7.ADDRESS

E. ACCESSORY STATUS
1.INVSNO 2.ITMSNO 3.ACESSORY ITEM DETAILS

CO
F. LICENCE DETAILS
1.INVSNO 2.ITMSNO 3.LIC SLNO 4.LIC NO 5.LIC DATE 6.CODE 7.PORT 8.DEBIT VALUE 9.QTY 10.UQC 11.DEBIT DUTY

G. CERTIFICATE DETAILS H.HSS DETAILS

1.CERTIFICATE NUMBER 2.DATE 3.TYPE 1.PRC LEVEL 2.IEC 3.BRANCH SLNO

I. SINGLE WINDOW DECLARATION

1.INVSN 2.ITMSNO3.INFO TYP 4.QUALIFIER 5.INFO CD 6.INFO TEXT 7.INFO MSR 8.UQC
1 1 CHR SQC 2 NOS
J. SINGLE WINDOW DECLARATION - CONSTITUENTS
OTHER ADDITIONAL INFORMATION

1.INVSN 2.ITMSNO 3.C SNO 4.NAME 5.CODE 6.PERCENTAGE 7.YIELD PCT 8.ING
ED

K. SINGLE WINDOW DECLARATION - CONTROL

1.INVSN 2.ITMSNO 3.CONTROL TYPE 4.LOCATION 5.SRT DT 6.END DT 7.RES CD 8.RES TEXT

L. SUPPORTING DOCUMENTS
1.INVSN 2.ITMSNO 3.TYP 4.ICEGATE ID 5.IRN 6.DOC CODE7.ISSUE PLACE8.ISSUE DT 9.EXP DT
SS

0 0 74000 RMANMR 2025052300018580 SINGAPORE 15-MAY-25

0 0 38000 RMANMR 2025052300018581 SINGAPORE 15-MAY-25
0 0 27100 RMANMR 2025052300018582 SINGAPORE 15-MAY-25
M. CONTAINER DETAILS
1.CONTAINER NUMBER 2.TRUCK NUMBER 3.SEAL NUMBER 4.FCL/LCL
SE

N. INVOICE DETAILS
1. S NO 2. INVOICE NO 3. INVOICE AMOUNT 4. CUR
1 91095425 1157.1 INR
AS

GLOSSARY
A : Ref No - SVB Reference Number, Ref Dt - SVB Reference Date; F : Code - Licence Scheme Code; G : PRC - Preceding; J : ING - Ingredient
K : RES CD - Control Result Code, RES TXT - Control Result Text

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 Port Code BE No BE Date BE Type
INMAA4 2228906 23/05/2025 W
IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - V - OTHER COMPLIANCES

A. EXAMINATION ORDER RMS

A1.EXAMINATION ORDER
B.EXAMINATION INSTRUCTIONS

B1. PGA EXAMINATION INSTRUCTIONS

Inv No Item No Agency Status

C.COMPULSORY COMPLIANCE

PY
D. AC REMARKS
E. EXAMINATION REPORT
F.SUPERINTENDENT COMMENTS
OOC No OOC Date

CO
D
SE
COMPLIANCES

S ES
AS

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 Port Code BE No BE Date BE Type
INMAA4 2228906 23/05/2025 W
IEC/Br 3496003171/55 FIRST COPY
GSTIN/TYPE 33AAACI4227Q1ZF/G
CB CODE AAAFR6574QCH001
INDIAN CUSTOMS TYPE INV ITEM CONT
PORT : ACC MEENAMBAKKAM, CHENNAI, TAMIL NADU - 600027 Nos 1 1 0
BILL OF ENTRY FOR WAREHOUSE BE PKG 1 G.WT (KGS) .5 BE0230520251214

PART - VI - DECLARATION
Declaration for 0/0: I/We declare that the contents of the above mentioned invoice(s) and documents are true and correct in every respect.I/We
have not received and do not know of any other documents or information showing a different description, quantity, price, value, of the said
goods and that if at any time hereafter I/We discover any document / information showing different facts, I/We will immediately make the same
known to the Commissioner of Customs.
Declaration for 0/0: I/We declare that the contents of this Bill of Entry for goods imported against above mentioned Bill of Lading/ Airway Bill
/Lorry Receipt/Railway Receipt numbers are in accordance with the above mentioned invoice(s) No(s)and other documents presented herewith.
Declaration for 1/0: I/We declare that the price paid or payable by the importer is as per the details provided above, and any price paid or
payable in addition to the above will be settled with the seller at the end of a defined period by means of debit note / credit note (post ¿ import
price adjustment), which are as per the contract attached as a supporting document.
Declaration for 1/0: I/We declare that there are no payments actually paid or payable for the imported goods by way of cost and services [in
terms of Rules 10(1)(a)(i), Rule 10(1)(a)(ii), Rule 10 (1) (a) (iii) and Rule 10 (1) (b) of Customs Valuation Rules, 2007], Royalty / Licence Fee /

PY
subsequent resale or use of goods /other payment as a condition of sale [(Please see Rule 10 (1) (c), (d) & (e) of Customs Valuation Rules,
2007] other than those declared in the invoice which are mentioned as miscellaneous charges in this Bill of Entry.

Declaration for 1/0: I/We declare that all conditions or restrictions, if any, imposed by the seller of any third party on the disposition or use of the
imported goods [as per proviso to Rule 3(2)) of the Customs Valuation Rules, 2007] are specified above.

CO
ED
A.DECLARATION STATEMENT

SS
SE
AS
B. AUTHORIZED
SIGNATORY

DATE

PLACE AUTHORISED SIGNATORY CHA NAME :RELIANCE MARITIME AGENCIES

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