KSO SUCOFINDO - SURVEYOR INDONESIA

VERIFICATION REQUEST

Refer to the terms and conditions of "KETENTUAN VERIFIKASI ATAU PENELUSURAN TEKNIS IMPOR (VPTI) Besi atau Baja, Baja Paduan, dan Produk Turunannya No. 36/KSO-
VPTI/XII/2016" that we have already read and understood, herewith we are submitting the VR as follows :

Commodity : Besi atau Baja, Baja Paduan, dan Produk Turunannya

VR. Submission No. : 2010210181
VR. Submission Date. : 21/10/2020 11:30:40

IMPORTER EXPORTER
Name : Name : CANGZHOU QIYUAN FOREIGN TRADE CO.,
PT. HYUNDAI ALUMINUM INTERNATIONAL
LTD
Contact : SEPTIYAWAN EFENDY Contact : MR ALBERT
Address : GRAHA SURVEYOR INDONESIA LT. 14 JL. Address : YIHE INTERNATIONAL JIEFANG XI ROAD
JEND. GATOT SUBROTO KAV. 56, KUNINGAN B-702, CANGZHOU, CHINA
TIMUR, SETIABUDI
City : JAKARTA SELATAN, DKI JAKARTA 12950 City :
Phone : 021-5265270 Country : CN
Fax : 021-5265270 Phone : +86-317-5512298
Email : septiyawan.hyundaialu@gmail.com;
Fax :
nud.hyundaial@gmail.com
NPWP : 85.424.998.4-067.000 Email : LANTONPAUL@163.COM
Status : API-U
API/NIB No. : 8120108860792

SUPPLIER
Supplier Name : CANGZHOU QIYUAN FOREIGN TRADE CO., LTD
Contact : MR ALBERT
Address : YIHE INTERNATIONAL JIEFANG XI ROAD B-702, CANGZHOU, CHINA
Country : CHINA
Telephone : +86-317-5512298
Mobile Phone :
Fax :
Email : LANTONPAUL@163.COM

Mode of Transport : SEA (FCL) Total Value : 35,717.58

Port Of Loading : TIANJINXINGANG Currency : USD
Port Of Discharge : TANJUNG PRIOK Incoterm : CIF
Date Of Shipment : 07/11/2020 Total Net Weight : 39,459.320 KGM
Date Of Discharge : 21/11/2020 Partial Shipment : Not Allowed

Pref.
No. HS Code Goods Description Origin Quantity Net Weight License No.
Facility

1. 73084090 SUPPORT V2(2.0-3.4M) CHINA 2,246.000 PCE 25,492.100 04.PI-05.20.2166

SPPT SNI:

2. 73084090 SUPPORT V3(2.4-3.8M) CHINA 440.000 PCE 5,478.000 04.PI-05.20.2166

SPPT SNI:

3. 73066190 SQUARE PIPE CHINA 283.000 PCE 3,367.700 04.PI-05.20.2166

SPPT SNI:

4. 73089099 HOOK CHINA 1,610.000 PCE 853.300 04.PI-05.20.2166

SPPT SNI:

5. 73182400 BEAM PIN CHINA 1,142.000 PCE 308.340 04.PI-05.20.2166

SPPT SNI:

6. 73182400 STUB PIN CHINA 45,740.000 PCE 2,881.620 04.PI-05.20.2166

SPPT SNI:

7. 73182400 WEDGE PIN CHINA 46,881.000 PCE 1,078.260 04.PI-05.20.2166

SPPT SNI:

Order/Invoice No. : FZY20201001

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 KSO SUCOFINDO - SURVEYOR INDONESIA

VERIFICATION REQUEST

Import License No. : 04.PI-05.20.2166

Remarks :

I herewith notify:
We understand and agree to pay 50% of inspection fee in advance when submitting Verification Request (transfer payment is attached) and will be completed the payment before or when
collected the LS or deposit payment

Name : SEPTIYAWAN EFENDY

FM.OPS.01 Revisi: 00 Hal. 2 dari 2