EXPRESS WORLDWIDE

2021-06-25 MYDHL+ 1.0 / *30-0821*

WPX
From : RH Origin:
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST BWI
21901 NORTH EAST Maryland
United States of America Contact: +14436741326

To : PT. URECEL INDONESIA Contact:

MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2 admin@urecel.co.id
Cibadak KM. 21
Bojong Cikupa
15710 TANGERANG
Indonesia

. ID-JKT-TXZ TN14
Day Time

C-DTP
Pce/Shpt Weight Piece
Ref:
28.7/282.2 lbs 1/5
EEI: AES ITN Request

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

(2L)ID15710+48000001

(J) JD01 4600 0088 3266 9480

EXPRESS WORLDWIDE
2021-06-25 MYDHL+ 1.0 / *30-0821*
WPX
From : RH Origin:
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST BWI
21901 NORTH EAST Maryland
United States of America Contact: +14436741326

To : PT. URECEL INDONESIA Contact:

MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2 admin@urecel.co.id
Cibadak KM. 21
Bojong Cikupa
15710 TANGERANG
Indonesia

. ID-JKT-TXZ TN14
Day Time

C-DTP
Pce/Shpt Weight Piece
Ref:
33.1/282.2 lbs 2/5
EEI: AES ITN Request

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

(2L)ID15710+48000001

(J) JD01 4600 0088 3266 9481

EXPRESS WORLDWIDE
2021-06-25 MYDHL+ 1.0 / *30-0821*
WPX
From : RH Origin:
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST BWI
21901 NORTH EAST Maryland
United States of America Contact: +14436741326

To : PT. URECEL INDONESIA Contact:

MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2 admin@urecel.co.id
Cibadak KM. 21
Bojong Cikupa
15710 TANGERANG
Indonesia

. ID-JKT-TXZ TN14
Day Time

C-DTP
Pce/Shpt Weight Piece
Ref:
33.1/282.2 lbs 3/5
EEI: AES ITN Request

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

(2L)ID15710+48000001

(J) JD01 4600 0088 3266 9482

EXPRESS WORLDWIDE
2021-06-25 MYDHL+ 1.0 / *30-0821*
WPX
From : RH Origin:
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST BWI
21901 NORTH EAST Maryland
United States of America Contact: +14436741326

To : PT. URECEL INDONESIA Contact:

MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2 admin@urecel.co.id
Cibadak KM. 21
Bojong Cikupa
15710 TANGERANG
Indonesia

. ID-JKT-TXZ TN14
Day Time

C-DTP
Pce/Shpt Weight Piece
Ref:
22.0/282.2 lbs 4/5
EEI: AES ITN Request

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

(2L)ID15710+48000001

(J) JD01 4600 0088 3266 9483

EXPRESS WORLDWIDE
2021-06-25 MYDHL+ 1.0 / *30-0821*
WPX
From : RH Origin:
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST BWI
21901 NORTH EAST Maryland
United States of America Contact: +14436741326

To : PT. URECEL INDONESIA Contact:

MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2 admin@urecel.co.id
Cibadak KM. 21
Bojong Cikupa
15710 TANGERANG
Indonesia

. ID-JKT-TXZ TN14
Day Time

C-DTP
Pce/Shpt Weight Piece
Ref:
165.3/282.2 lbs 5/5
EEI: AES ITN Request

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

(2L)ID15710+48000001

(J) JD01 4600 0088 3266 9484

*WAYBILL DOC*
Not to be attached to package - Hand to Courier
2021-06-25 MYDHL+ /
WPX
Shipper :
Contact:
RH +14436741326
Shelia Dempsey
4000 PRINCIPIO PARKWAY EAST
21901 NORTH EAST Maryland
United States of America
Receiver : Contact:
PT. URECEL INDONESIA MIRA KANTI
MIRA KANTI +6281312815201
Jl. Industry Raya Kav. 2
Cibadak KM. 21
admin@urecel.co.id
Bojong Cikupa
15710 TANGERANG
Indonesia

. US-BWI-SBY ID-JKT-TXZT N 1 4
Product Details: Features / Services (Service Code)

[P] EXPRESS WORLDWIDE (48) Emergency Situation(CR)

Payer Details Oversize Piece(YY)
Freight A/C: 848712138 Duties & Taxes Paid(DD)
Duty A/C: 848712138
Taxes A/C: 848712138

Shipment Details
Ref:
Custom Val: 9,030.84 USD
EEI: AES ITN Request
Cust Decl Shpt Wgt (UOM) / Dim Wgt (UOM): Pieces

282.2 lbs 5
Name (in Capital Letters) Signature Date (DD.MM.YYYY)

Contents: Pillows
cushion s and similar
furnishing except of
cotton, for sam pling

WAYBILL 55 7894 8546

License Plates of pieces in shipment
JD014600008832669480
JD014600008832669481
JD014600008832669482
JD014600008832669483
JD014600008832669484

- page 1 of 1 -
 Proforma Invoice
AWB No: 5578948546 Invoice Date: 2021-06-28 Invoice No:

SHIP FROM: SHIP TO:

RH PT. URECEL INDONESIA
Shelia Dempsey MIRA KANTI
4000 PRINCIPIO PARKWAY EAST Jl. Industry Raya Kav. 2
Cibadak KM. 21
Bojong Cikupa
NORTH EAST, 21901 TANGERANG, 15710
Maryland
United States of America Indonesia
+14436741326 +6281312815201
sdempsey@rh.com admin@urecel.co.id
Trader Type:BUSINESS Trader Type:BUSINESS
VAT No: VAT No:
EORI: EORI:
TAX ID:

Shipper Reference:
Receiver Reference:

Remarks:

Item Description C o m m o - GST Net / COO Reference Type & QTY Unit Sub Total
dity Code paid Gross Value
Weight ID Value

1 Pillows cushions and similar furnishing OB:9404. 20.15 lb MEXICO ECCN=EAR99 14.00 PCS 645.06 9,030.84
except of cotton, for sampling 90.2000 20.15 lb USD USD

Total Goods Value: 9,030.84 USD Total line items: 1

Total Invoice Amount: 9,030.84 USD Number of Pallets: 0
Currency Code: USD Total units: 14.0
Terms of Payment: Package Marks / Other Info:
Terms of Trade: Delivered Duty Paid
Place of Incoterm:
Reason for Export: Sample
Type of Export: Permanent
Total Net Weight: 282.10lb Payer of GST / VAT:
Total Gross Weight: 282.10lb Duty / taxes acct: 848712138
Requiere Pedimento: No
Duty / tax billing service:
Carrier: DHL
Ultimate Consignee:
Exemption Citation: EEI: AES ITN Request

These items are controlled by the U.S. government and authorized for export only to the country of ultimate destination for use by the ultimate consignee or end-user(s) herein
identified. They may not be resold, transferred, or otherwise disposed of, to any other country or to any person other than the authorized ultimate consignee or end-user(s), either in
their original form or after being incorporated into other items, without first obtaining approval from the U.S. government or as otherwise authorized by U.S. law and regulations.

I/We hereby certify that the information contained in the invoice is true and correct and that the contents of this shipment are as stated above.

Name: Shelia Dempsey Signature: Company Stamp

Position:
Date of Signature:
Page 1 of 1
 Proforma Invoice
AWB No: 5578948546 Invoice Date: 2021-06-28 Invoice No:

SHIP FROM: SHIP TO:

RH PT. URECEL INDONESIA
Shelia Dempsey MIRA KANTI
4000 PRINCIPIO PARKWAY EAST Jl. Industry Raya Kav. 2
Cibadak KM. 21
Bojong Cikupa
NORTH EAST, 21901 TANGERANG, 15710
Maryland
United States of America Indonesia
+14436741326 +6281312815201
sdempsey@rh.com admin@urecel.co.id
Trader Type:BUSINESS Trader Type:BUSINESS
VAT No: VAT No:
EORI: EORI:
TAX ID:

Shipper Reference:
Receiver Reference:

Remarks:

Item Description C o m m o - GST Net / COO Reference Type & QTY Unit Sub Total
dity Code paid Gross Value
Weight ID Value

1 Pillows cushions and similar furnishing OB:9404. 20.15 lb MEXICO ECCN=EAR99 14.00 PCS 645.06 9,030.84
except of cotton, for sampling 90.2000 20.15 lb USD USD

Total Goods Value: 9,030.84 USD Total line items: 1

Total Invoice Amount: 9,030.84 USD Number of Pallets: 0
Currency Code: USD Total units: 14.0
Terms of Payment: Package Marks / Other Info:
Terms of Trade: Delivered Duty Paid
Place of Incoterm:
Reason for Export: Sample
Type of Export: Permanent
Total Net Weight: 282.10lb Payer of GST / VAT:
Total Gross Weight: 282.10lb Duty / taxes acct: 848712138
Requiere Pedimento: No
Duty / tax billing service:
Carrier: DHL
Ultimate Consignee:
Exemption Citation: EEI: AES ITN Request

These items are controlled by the U.S. government and authorized for export only to the country of ultimate destination for use by the ultimate consignee or end-user(s) herein
identified. They may not be resold, transferred, or otherwise disposed of, to any other country or to any person other than the authorized ultimate consignee or end-user(s), either in
their original form or after being incorporated into other items, without first obtaining approval from the U.S. government or as otherwise authorized by U.S. law and regulations.

I/We hereby certify that the information contained in the invoice is true and correct and that the contents of this shipment are as stated above.

Name: Shelia Dempsey Signature: Company Stamp

Position:
Date of Signature:
Page 1 of 1