PT POS INDONESIA (Persero) CUSTOMS DECLARATION CN 23

From Sender customs reference No. of item (barcode, if

De Name : iffah fadilah NIK-1107096708890001 | Maybe opened officially
any)
Address : gampong meunasah intan DECLARATION EN DOUANE
No. of item (barcode, if | Maybe opened officially
Address (count)
any)
Postcode : 23370 City : KAB. ACEH BESAR
State ACEH Country : ID-INDONESIA Declaration ID
To Name : itsuko kumazaki CDS0821194142
A
Address : 12506 seto Importer's references (if any) {tax code/VAT No./importer code) (optional)
Address (count)
Postcode 5080111 City nakatsugawa city Importer's telephone/fax/email (if known)
State gifu prefecture Country JP-JAPAN
810573655353 mrenglishcoffee@docomo.ne.jp

Net weight (3) Total weight (4) For commersial item only
Detailed description of contents (1) Quantity (2) (in kg) Value (5) Total Value (6)
HS tarif number (7) Country of origin of goods (8)
wallet aceh 3 0,4 8.28 USD 420231
t shit aceh 0,2
1 6.21 USD 610990
0,8 17.94 USD
coffee aceh 1 0,1 2.76 USD 210111
gantungan kunci aceh 1 0,1 0.69 USD 392690

Category of item (10) Sales of goods Commercial sample Office origin/Date of posting
X Gift Returned Goods Other
02/08/2021 09:43
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 02/08/2021 09:43