BPI Q FORM 4

Republic of the Philippines

Department of Agriculture
BUREAU OF PLANT INDUSTRY

PLANT QUARANTINE SERVICE

Manila

Application for inspection and

Phytosanitary Certification
Date _______________

The Director
Bureau of Plant Industry
Manila

I/WEYUMI GOLDEN FIELD, INC.,NATIONAL HIGHWAY LIWANAY, BANGA, SOUTH COTABATO 9511 PHILIPPINES
(Name, Address and Telephone No. of Exporter)
Hereby request for inspection and certification of the following plant materials intended for export.

Common Name :COCOPEAT

Scientific Name :CocosNucifera
Quantity (Specify Unit)* :23,000 kgs.NET WEIGHT
Description & No. Packages :1X40 FOOTER VAN SAID TO CONTAIN COCOPEAT IN BLOCK
Source of Plants/Plant Products :COCONUT HUSK
Name & Address of Consignee :NONGKYUNG CO., LTD.
894-32 Chogeum-lo, Deoksan-myeon. Jincheon-gun, Chungcheongbuk-do; Jincheon-gun,
Chungcheongbuk-do, South Korea 27851
NOTIFY: SANG HA PARK
SAME ADDRESS; H.P. N0.: 82-10-83777630
E-mail: shp7630@daum.net
Date and Place of Inspection Desired :________________________________________
Port of Entry :BUSAN, SOUTH KOREA
Means of Conveyance :SEAWAY
Flight no./Voyage No. : SPECTRUM V923N
Departure Date :
Import Permit No./Additional :
Declaration/Treatment (if any) : Fumigated with Methyl bromide
48 grams/cubic meter @32 degree Celsius

(Signature of Applicant/Authorized Representative)

STAMP OF THE SERVICE

Samuel Olivar/ representative
(Name & Designation of Applicant/
Authorized Representative)

 For Plants - no. of Pieces