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KEMENTERIAN KESEHATAN RI

DIREKTORAT JENDERAL PENGENDALIAN PENYAKIT DAN PENYEHATAN LINGKUNGAN


KANTOR KESEHATAN PELABUHAN KELAS I MEDAN
Jalan Veteran No. 219 Belawan 20411 Telepon : (061) 6941343, Faximile : (061) 6940718 SERTIFIKAT KESEHATAN HEALTH CERTIFICATE Number :
This Health Certificate is to certify that the commodities described below or representative samples of them were thoroughly eamined by authorized officer of the Port Health Office of Medan, and were found HEALTHY and fit for human comsumption. Commodities Desription 1. Name of commodities 2. Weight Nett Gross : INDONESIAN BLACK TEA BPS

: 25,660.00 KGS : 25,968.00 KGS : 440 PAPER SACKS OF INDONESIAN


BLACK TEA WITH DOUBLE WPPE COVER

3. Number and Description of Packages 4. Name and address of manufacturer (exporter)

: PT. JAKARTA TEA TRADERS


JL. BENDA RAYA NO. 12C KEMANG CILANDAK TIMUR JAKARTA 12560 - INDONESIA

5. Name and address of importer

: KEIVAN TARABAR TOOS INTERNATIONAL


TRANSPORT CO. BANDAR ABBAS : OFFICE BUILDING 44 HOMA HOTEL FORKED ROAD PASDARAN BLVD BANDAR ABBAS (IRAN) TEL/FAX : 0098761551237 MOBILE : 00989171614330

6. Country of Origin 7. Port / Airport of loading 8. Port / Airport of discharge 9. Sipping / Flight mark 10. Remarks

: INDONESIA : BELAWAN, INDONESIA : BANDAR ABBAS (IRAN) : PEARLRIVER BRIDGE V. 311N : ON ONE SIDE OF THE PP WOVEN BAGS :
INDONESIAN BLACK TEA BPS NETT WEIGHT : .........................KGS GROSS WEIGHT :..........................KGS ON OTHER SIDE OF THE PP WOVEN BAGS : R. H. LTD BA 04 INTRANSIT TO KABUL AFGHANISTAN VIA BANDAR ABBAS PRODUCTION DATE : 03/2013 EXPIRY DATE : 02/2016

CONTAINER NO. HJCU 1667840 SEAL NO. HC889627

Medan, Port Health Officer

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