1. Goods consigned from (Exporter's business name, address, country) Reference No.

PT PACIFIC LUBRITAMA INDONESIA

JL. KALI ASIN KP. LUMALANG, BOJONEGARA
INDONESIA
ASEAN TRADE IN GOODS AGREEMENT
ASEAN INDUSTRIAL COOPERATION SCHEME
CERTIFICATE OF ORIGIN
2. Goods consigned to (Consignee's name, address, country) (Combined Declaration and Certificate)
OUR LUBRICANTS SDN BHD FORM D
NO.2A, JALAN SKI 1/KU7, Issued in INDONESIA
KAWASAN INDUSTRI HI-TECH (Country)
SUNGAI KAPAR INDAH,
42200 KLANG ,SELANGAR See Overleaf Notes
ATTN : MS.CINDY
3. Means of transport
TEL : 03-3292 7522and route (as far as known) 4. For Official Use
MALAYSIA
Preferential Treatment Given Under ASEAN
Departure Date SEPTEMBER 11, 2020 Trade in Goods Agreement

Preferential Treatment Given Under ASEAN

Vessel's name/Aircraft etc. BEETHOVEN V.001N Industrial Cooperation Scheme

Preferential Treatment Not Given (Please

State reason's)
Port of Discharge PORT KLANG, MALAYSIA
.................................................................................................................
Signature of Authorised Signatory of the Importing Country

5. Item 6. Marks and 7. Number and type of packages, description 8. Origin criterion 9. Gross weight or other 10. Number and
number numbers on of goods (including quantity where (see Overleaf Notes) Quantity and Value date of
packages appropriate (FOB) where RVC is Invoices
and HS number of the importing country) applied

1 N/M 1X40 HQ RVC 100 % GW : PLI-EKS/2020/09/0

1368 PACKAGES OF 25,312.39 KGM 18
RNS103E55L - REPSOL DXR 3 40 CF/SF (TWENTY-FIVE THOUSAND SEPTEMBER 9,
49 CARTONS (6X5L) THREE HUNDRED AND 2020
RNS004Q51L - REPSOL GXR 3 20W-50 TWELVE POINT
SG/CD THIRTY-NINE)
30 CARTONS ( 24X1L) NW :
RNS301S51L - REPSOL RSGEAR EP5 23,473.80 KGM
85W140 GL-5 (TWENTY-THREE
14 CARTONS (24X1L) THOUSAND FOUR
RNS301J51L - REPSOL RSGEAR EP5 90 GL-5 HUNDRED AND
19 CARTONS (24X1L) SEVENTY-THREE POINT
RNS206X51L - REPSOL MXR PLUS 10W-40 EIGHTY)
API JASO MA2 25 CARTONS (12X1L) USD 44,720.60
RNS205Q51 - REPSOL MXR 5 20W50 SL (FORTY-FOUR THOUSAND
JASO MA2 SEVEN HUNDRED AND
150 CARTONS (12X1L) TWENTY POINT SIXTY)
RNS005J54L - REPSOL GXR EURO 5W-40
API SN/CF
91 CARTONS ( 6X4L)
RNS001X54L - REPSOL GXR PLUS 10W-40
SN
110 CARTONS (6X4L)
HS: 27101943

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above details and statement It is hereby certified, on the basis of control carried out, that the declaration
are correct; that all the goods were produced in by the exporter is correct.

INDONESIA
ISSUING OFFICE IN KABUPATEN SERANG
......................................................................................................................
(Country)
and that they comply with the origin requirements specified for
these goods in the ASEAN Trade in Goods Agreement for the goods
exported to

MALAYSIA
......................................................................................................................
(Importing Country)

KABUPATEN SERANG,
......................................................................................................................
Place and date, signature of authorised signatory

13.
v Third Country Invoicing Exhibition

Accumulation De Minimis

Back-to-Back CO Issued Retroactively

,
.......................................................................................................................................
Partial Cumulation
Place and date, signature and stamp of certifying authority

Page 1 / 2
1. Goods consigned from (Exporter's business name, address, country) Reference No.
PT PACIFIC LUBRITAMA INDONESIA
JL. KALI ASIN KP. LUMALANG, BOJONEGARA
INDONESIA
ASEAN TRADE IN GOODS AGREEMENT
ASEAN INDUSTRIAL COOPERATION SCHEME
CERTIFICATE OF ORIGIN
2. Goods consigned to (Consignee's name, address, country) (Combined Declaration and Certificate)
OUR LUBRICANTS SDN BHD FORM D
NO.2A, JALAN SKI 1/KU7, Issued in INDONESIA
KAWASAN INDUSTRI HI-TECH (Country)
SUNGAI KAPAR INDAH,
42200 KLANG ,SELANGAR See Overleaf Notes
ATTN : MS.CINDY
3. Means of transport
TEL : 03-3292 7522and route (as far as known) 4. For Official Use
MALAYSIA
Preferential Treatment Given Under ASEAN
Departure Date SEPTEMBER 11, 2020 Trade in Goods Agreement

Preferential Treatment Given Under ASEAN

Vessel's name/Aircraft etc. BEETHOVEN V.001N Industrial Cooperation Scheme

Preferential Treatment Not Given (Please

State reason's)
Port of Discharge PORT KLANG, MALAYSIA
.................................................................................................................
Signature of Authorised Signatory of the Importing Country

5. Item 6. Marks and 7. Number and type of packages, description 8. Origin criterion 9. Gross weight or other 10. Number and
number numbers on of goods (including quantity where (see Overleaf Notes) Quantity and Value date of
packages appropriate (FOB) where RVC is Invoices
and HS number of the importing country) applied

2 N/M RNS002Y54L - REPSOL GXR 7 15W-40 SN RVC 100 % GW : PLI-EKS/2020/09/0

108 CARTONS (6X4L) 25,312.39 KGM 18
RNS302U54L - REPSOL ATFLUID IIIH (TWENTY-FIVE THOUSAND SEPTEMBER 9,
160 CARTONS ( 6X4L) THREE HUNDRED AND 2020
RNS302U54L - REPSOL ATFLUID IIIH TWELVE POINT
1 CARTONS (6X4L) THIRTY-NINE)
RNS300J54L - REPSOL RSGEAR EP4 90 GL-4 NW :
107 CARTONS (6X4L) 23,473.80 KGM
RNS206X51L - REPSOL MXR PLUS 10W-40 (TWENTY-THREE
API THOUSAND FOUR
JASO MA2 292 CARTONS (12X1L) HUNDRED AND
RNS205Q51 - REPSOL MXR 5 20W50 SL SEVENTY-THREE POINT
JASO MA2 EIGHTY)
42 CARTONS ( 12X1L) USD 44,720.60
RNS205Q51 - REPSOL MXR 5 20W50 SL (FORTY-FOUR THOUSAND
JASO MA2 SEVEN HUNDRED AND
78 CARTONS (12X1L) TWENTY POINT SIXTY)
RNS005J54L - REPSOL GXR EURO 5W-40
API SN/CF
92 CARTONS (6X4L)

HS: 27101943

THIRD PARTY UNITED OIL COMPANY PTE

LTD INVOICE NO.RS/PLI-20/04-11/U50120
DATED 10.09.2020
SINGAPORE
11. Declaration by the exporter 12. Certification
The undersigned hereby declares that the above details and statement It is hereby certified, on the basis of control carried out, that the declaration
are correct; that all the goods were produced in by the exporter is correct.

INDONESIA
ISSUING OFFICE IN KABUPATEN SERANG
......................................................................................................................
(Country)
and that they comply with the origin requirements specified for
these goods in the ASEAN Trade in Goods Agreement for the goods
exported to

MALAYSIA
......................................................................................................................
(Importing Country)

KABUPATEN SERANG,
......................................................................................................................
Place and date, signature of authorised signatory

13.
v Third Country Invoicing Exhibition

Accumulation De Minimis

Back-to-Back CO Issued Retroactively

,
.......................................................................................................................................
Partial Cumulation
Place and date, signature and stamp of certifying authority

Page 2 / 2