PROFORMA INVOICE

"[Your Company Name]"

[Address] INVOICE No [100] [Town, County Postal Code] DATE: 5 April, 2018 Phone [01234 567890] Fax [01234 567890]

Billing Address: Delivery Address:

Galaxy Holding ltd. Galaxy Holding ltd. Tr. 1.maje 66/24a Tr. 1.maje 66/24a 460 01 Liberec 3, Czech Republic 460 01 Liberec 3, Czech Republic Company Reg. ID: 22774025 TAX ID: CZ22774025 Phone: +420 485 104 492 FAX: +420 485 104 492 e-mail: [email protected]

Repacking and service of the following Galaxy Rescue Systems:

QUANTITY DESCRIPTION UNIT PRICE AMOUNT 1 GRS 3/350 OUT (No.: 3699-08-0012-4425) EUR 50,- EUR 50,-

The price of goods only for Customs procedure.Goods sent free of charge.

SUBTOTAL EUR 50,- SHIPPING COST EUR 100,- TOTAL DUE EUR 150,-

SARS Customs Tariff Code : 88.040000

Note: please specify serial number for all devices you send for repacking and service

THANK YOU FOR YOUR COOPERATION!