PT POS INDONESIA (Persero) CUSTOMS DECLARATION CN 23

From Name : Oki Darmawan Sender customs No. of item (barcode, if any) | Maybe opened officially
De reference (if any)
Address : Pedongkelan DECLARATION EN DOUANE
Address (count) No. of item (barcode, if any) | Maybe opened officially
Postcode : 13210 City : KOTA ADM. JAKARTA TIMUR
State DKI JAKARTA Country : ID-INDONESIA Declaration ID
To Name : Chutima C D S 0 2 2 1 8 9 5 7 6 1
A
Address : Pruksa 64 no 1 Tanon kolngsam kolngsam klongluang Importer's references (if any) {tax code/VAT No./importer code) (optional)
Address (count)
Postcode 12120 City Bangkok Importer's telephone/fax/email (if known)
State Klongluang Country TH-THAILAND 0816170963 Tima0975@gmail.com

Net weight (3) For commersial item only

Detailed description of contents (1) Quantity (2) Total weight (4) Value (5) Total Value (6)
(in kg) HS tarif number (7) Country of origin of goods (8)
Kopi 1 24,0 24,0 42.70 USD 42.7 USD 210111
Category of item (10) X Sales of goods Commercial sample Office origin/Date of posting
Gift Returned Goods Other
04/02/2021 11:58
Documents Mixed content
Comments (11) : (e.g goods subject to quarantine, sanitary/phytosanitary inspection or other restriction) I certify that the particulars given in this custom
declaration are correct and that this item does not
contain any dangerous article or articles prohibited by
legisation or by postal or customs regulations
Licence (12) Certificate (13) Invoice (14) Date and sender's signature (15)
No(s). of licence(s) No(s). of certificate(s) No(s). of invoice 04/02/2021 11:58