PROFORMA INVOICE

Exporter : Invoice No & Date Exporter's Ref

SYMBOLIFE PHARMA 000051 23-01-2024 IEC Code : AEKFS9740P
SHOP NO-L-9, DURVAS CHS, OPP DMART YASHWANT
VIVA TOWNSHIP, VASAI(EAST)-401209 Buyer Order No. & Date 6120-23 11/12/2023

Pan No .AEKFS9740P LUT No :

Mob No : 9167496132
GST No. 27AEKFS9740P1Z0
Web : www.symbolifepharma.com Email : [email protected]
State : MAHARASTRA State Code :27
Consignee
Notify :
TO THE ORDER OF LABQUIFAR LTDA.
TO THE ORDER OF LABQUIFAR LTDA.
NIT 800.204.388-0, 37A 25-52 CITY BOGOTA COUNTRY COLOMBIA. PHONE
NO. +573204882787 COLOMBIA 999999 NIT 800.204.388-0, 37A 25-52 CITY BOGOTA COUNTRY
COLOMBIA. PHONE NO. +573204882787 COLOMBIA 999999

Tel No : / Email ID :
TO THE ORDER OF LABQUIFAR LTDA.
Buyer ( if other than Consignee )
NIT 800.204.388-0, 37A 25-52 CITY BOGOTA COUNTRY
TO THE ORDER OF LABQUIFAR LTDA. COLOMBIA. PHONE NO. +573204882787 COLOMBIA
NIT 800.204.388-0, 37A 25-52 CITY BOGOTA COUNTRY COLOMBIA. PHONE NO. 999999
+573204882787 COLOMBIA 999999 OTHER CONTRIES

Tel : // Email :
Country of Origin of Goods Country of Final Destination
INDIA COLOUMBIA
Pre Carriage By Delivery Terms : Place of Receipt by Pre-Carrier Inco Terms Payment Terms :50%
BY SEA BUENAVENTURA SEAPORT CIF BUENAVENTURA ADVANCE & 50% AT SIGHT
SEAPORT
LC No./BC No./Dt Port of Loading Bank Details
MUMBAI JNPT ICICI BANK LIMITED
Port of Discharge Final Destination REIS MAGOS, RAMDAS SUTRALE MARG, OFF
BUENAVENTURA SEAPORT BUENAVENTURA SEAPORT
CHANDAVRKAR ROAD, BORIVALI WEST, MUMBAI,
MAHARASHTRA 400092
Account No .:001805016947 SWIFT :ICICINBBCTS
AWB/BL NO. & Date Dispatch Through
IFSC :ICIC0000018

Marks & Nos./ Description of Goods Quantity Rate USD Amount

Container No. PHARMACEUTICAL INGREDIENT OF INDIAN ORIGIN IN USD

BETAMETHASONE DIPROPIONATE USP 25,00 Kgs 845,0000 24,927.50

HSN CODE :29372100 Other HSN Code :
Make :
Packing : 25 x 1

SILVER SULFADIAZINE 200,00 Kgs 335,0000 79,060.00

HSN CODE :29359013 Other HSN Code :
Make :
Packing : 25 x 8

Total No of : 8 Indent No 6120-23 11/12/2023

FOB 88.125,00
Gross Weight : 234,00 Kgs :
N.T.N. No : Freight 0
Tare Weight : 9,00 Kgs
Insurance 0
Net Weight : 225,00 Kgs

Amount Chargeable USD EIGHTY-EIGHT THOUSANDS ONE HUNDRED TWENTY-FIVE ONLY. Total In USD : 88.125,00
(in words)

Declaration :
1.Drawback Declaration:
(I)DBK001 - I declare that no input tax credit of the central Goods and Services Tax or of the Integrated For SYMBOLIFE PHARMA
Goods & Services tax has been availed for any of the inputs or input services used in the manafacture of the
export goods OR DBK002- I declare that no refund of integrated Goods and Services Tax paid on the export
goods shall be claimed AND (II)DBK003- I declare that CENVAT creit on the input or inout services used in
the manufature of the export goods has been carried forword in terms of the Central Goods and Services Tax
Act 2017.
2.We intend to claim rewards under Merchandise Exports From India Scheme(MEIS)/(RoDTEP).
3.we abide by provisional of foregin exchnge management Act regarding realization.
4.We declare that this invoice shows the actual price of the goods described and all particulars are true and
Director / Authorised Signatory
correct. Place - Mumbai