66409415006

1. Exporter's Name and Address CERTIFICATE NO. 0040386/KTG/2017

PT BUMITANGERANG MESINDOTAMA
JL. DIPATI UNUS NO. 30 CIBODAS
TANGERANG 15138-BANTEN, INDONESIA

INDONESIA PAKISTAN
2. Consignee's Name and Address PREFERENTIAL TRADE AGREEMENT (IPPTA)
M/S VOLKA FOOD INTERNATIONAL LIMITED. CERTIFICATE OF ORIGIN
3-KM, BAHAWALPUR BYPASS, BAHAWALPUR
ROAD, MULTAN. CONTACT PERSON : MUHAMMAD WASEEM SHAHZAD
(Combined Declaration and Certificate)
TEL : +92 333 607 6542
FORM IP
3. Producer's Name and Address
SAME Issued in INDONESIA
(Country)

See Overleaf Notes

4. Means of transport and route (as far as known) 5. For Official Use Only

Departure Date : NOVEMBER 27, 2017 Preferential Treatment Given Under IPPTA

Vessel /Flight No. : ST GREEN V. 051N

Preferential Treatment Not Given Under IPPTA
Port of loading : JAKARTA, INDONESIAN SEAPORT
(Please state reason/s)
Port of discharge : KARACHI SEAPORT, PAKISTAN

.............................................................................................................
Signature of Authorized Signatory of the Importing Country
6. Item number 7. Marks and numbers on packages; Number and kind of 8. Origin Criterion 9. Gross Weight, Quantity and 10. Number and date of
packages; description of goods; HS code of the importing FOB value invoices
country

1 560 BG WO 14,140 KGM 623/INV/XI/17

1X20' CONTAINER STC : (FOURTEEN THOUSAND ONE NOVEMBER 21, 2017
14 MT OF INDONESIAN ALKALIZED COCOA POWDER HUNDRED AND FORTY)
(BT360) FURTHER DETAILS ARE AS PER USD 25,700
BENEFICIARY'S PROFORMA INVOICE NO.120/PI/X/17
DATED OCTOBER 25, 2017. CFR KARACHI
SEAPORT-PAKISTAN(INCOTERMS:2010). COUNTRY OF
ORIGIN : INDONESIA, THE GOODS IMPORTABLE UNDER
H.S CODE NO.1805.0000.14 MT (560 BAGS@25KGM). NW
: 14,000.00 KGM

CONTAINER AND SEAL :

PCIU1882222/X0811684
HS No.:1805000000

11. Remarks

12. Declaration by the exporter 13. Certification

The undersigned hereby declares that the above details and statement It is hereby certified, on the basis of control carried out, that the
are correct; that all the goods were produced in declaration by the exporter is correct.

INDONESIA
.................................................................................................................... MUNICIPALITY OFFICE IN TANGERANG
(Country)

and that they comply with the origin requirements specified these goods
in the Rules of Origin under Indonesia-Pakistan PTA for the goods
exported to

PAKISTAN
....................................................................................................................
(Importing Country)

LOVITA
PT BUMITANGERANG MESINDOTAMA OKE SULENDRO SETYO RACHMAN
TANGERANG, NOVEMBER 28, 2017
.................................................................................................................... TANGERANG, NOVEMBER 28, 2017
.....................................................................................................................
Place and date, name, signature and company of authorised signatory Place and date, signature and stamp of Authorized issuing Authority/Body

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