1.        Goods consigned from (Exporter’s business name..)

Address country:

PT.NUSA INDAH JAYA

JL. KEBON BAWANG VI NO.xx

KEBON BAWANG,TANJUGPRILK

JAKATRAUTARA 143xx INDONESIA

 

 

Reference No.   00964/JKB/2010

ASEAN CHINA FREE TRADE AREA

PREFERENTIAL TARIFF

CERTIFICATE OF ORIGN

(combined declaration certificate)

FROM E

Issued in INDONESIA

(Contry)

(see notes overleaf)

2.        Goods consigned to Consignee’s name, address,country

JIANGMEN HONGXING ECONOMY TRADING LMP.& EXP,L/T/D

ROOM xxx,NO.xx KANGKOU 2 ROAD JIANGMEN GUANGDONG

TEL:010-82281XXX    FAX:020-82281XXX

3.        Means of transport and route (as far as known)

Deoature date

MAY 02,2010/11/16

Vessels name/ aircraft etc

NAJADE 1010

Port of discharge

HUANGPU OLD PORT,CHINA

4.        For OFFICIAL Use

Preferential treatment given ASEAN-CHINA

Free trade Area preferential taniff

_______________________

Preferential treatment not given (please state reasons)

_______________________

-----------------------------------

Signature of authorize signature of the country

5.ITEM number

6.marks and numbers on packages

CONT No.:

MWCU5336689

SEAL NO.:ML-ID0840482

7.Number and type of packages ;description of goods including quantity where appropriate and HS number of importing country

1×40’ RH S.T.C.

2,720 master cartons

-FROZEN RIBBON FISH HS.0303.79.1000

8.Origin criterion (see Notes overleaf)

“X”

9.Gross weight or other quantity and value(FOB)

 

 

27.200.00KGS

USD 17,080.00

10.Number and date of invoice

095/NIJ/iv/10

April 27,2010

 

11.Declaration by the exporter

The undersigned hereby declares that the above details and statement are correct ,that all the goods were produced in INDONESIA

And that they comply with the origin requirements specified for the goods in the ASEAN-CHINA free trade Area preferential tariff for the goods exported to CHINA(Importing country)

JAKARTA,MAY4,2010

Place and date,signature of authorized signatory

 

12. Certification

It is hereby certified ,on the basis of control carried out, that the declaration of the exporter is correct.

 

JAKARTA,MAY4,2010

Place and date signature and stamp of certifying authority