c6ue rv PREVIEW

Reference No. B- 10100?-('('F-s I l'1-10-H-0 I 69 5 l

dhfrb consisldtfftm (E-xpolti'fl business name,
.t
r.

ASEAN TRADE lN GOODS AGREEME}'IT/

ASEAN INDUSTRIAL COOPER.ATION SCHEME
l,\1. ('ON1l'l.l]\ CEBTIFICATE OF OBIGIN
tR. N1:\l A\'\lA {Cornbtred Dedara{on and Certfi cata)

7. G"od. i" (Co"iignee's name, address, counlry)

"ortE".d
\11\lli)\l l'tll \t\\l'ir\( II'Rl:'t lt'\l)lN(i(() I ll)
l()1.'\-.15 llli-\10 llil.slRI l:t -l\ li\lt
i ()t. I.iltt,S I l{1,\j1,.\ltK.lI\ll lltlN(, 1l(),\.lrt
\\',\ltl).lll\li t\\ I)lSli{l( LII( )( lll\ll\ll
( ll\ \'ll l\'\\4 ,
For ol{icial use
S.veans ot iiansporl and route (as lar as known)

Departure Date:

ll \Rl l llvllr IRANSI'OR l n Pre'lsrenlial Treatrrtenl Given Under ASEAN

Trade in Gaods Agreemenl

n
.luh' lOlt)lrv 11

Pr€fetential Treatment Given Under ASEAN

lnoustrial Cooperation Schame
vessel's Name/Aircraft, olc.:

YN.l lll,l(;ti ls \' lt)0('

FI:l':t)lrl{ \'}:Stilll . N.'\N'lH U ARN()W \1A51L'

Porl of Dischatge:
(AII-At
R V 005S
tl Prefer€ntial Troatmenl Not Given
(Pleass state r€asods)

Signature of Authorised Signatory of the

7. Numher and typc of packages, description of goods 8. Origin | 9. Gross weigtrt

(including quantity lvhore appropriatts and HS number criterion ] or others

ol the impoding counlry)

(see QuantltY and
Overteal I vatue tFOB)
Notes) J where RVC

15150 K(iS li l0 01.lt],.r

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l,XP(Jlrl l\(; ('()l N l R\' llS ('()l)l 72lq'ilrr()(xr

('Isil L ltt K<;s }] 20 01109

IUl rNI)l tl 0)/t)7:2021)
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'11
. Declaration bY lhe sxporter
i1 is rloreoy cortified, on th6 basis 01 control cariled out'
The undersigned hereby declares that the above details and
produced in
staternent aie correct; that alt the qoods lvere
\1..\ L. \\',S l.\
SAO CHfNE
(CountrY)
Ngiy,,,,,,.thing*
and that they comPly with lhe origin requiremenls specified
for these goods in lhe ASFAN Trade in Goods Agreemenl 1i,r
'BAN
Scerilill' (
icrrcr'rl
ior th6 goocls oxportecl to \lrilr\tn ()l l,lt(rltllt,rNl llrdr rncl ltltlusttl
\I1 L\\\1 \'lalal'sra
l,rhlt ilrrhttt.lohrr I 6 Ilrlv :()l()
l( l'l -( (I -\\-:(l0rl.\-,1]-()(r(x)l0l

.-
Plac€ and date, si0nalure ol authorised signalory
pd;;;il ;;i;, ,"J ;hmp of cerlitving authoritv
"ifi;ili"
13.

D Third-Coun1ry lnvolcing I Exhionlon

D Accumulation I De Minlmis

I Back-to-Back CO Z lssuod Betroactively

 INSPECTION CItRTIITICA'I'E 3. I

,r,( ( (.)1iL)tNC I1) [\ 10201

(, tattI'l l:tc.\'t {i NO Rcy ISSUD D,I'TH

2'i8 ! 02 I r02lt-07"01{

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N1EI.'1'INC PROCF.SS

No.
EAF, AOD
DIILIVERY NOTI No.

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cus'r'ot\!uR O ILDCR No.
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As;(E BPVC-IIA S I{0 I s^:d0r,1.20}i o',1t. 104

tiN l003$.l-201r I.l.\0? l l30l

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(.lri,\N-nlr' I l'roT^t,Il^ss ?610 Kg
No. lll r 2ll
PRODUCl' DliuuNsl0lis o,8nrnr x 152'l nns x COIL
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