Reference No.

 
VN-TH 22/04/06165
1. Goods Consigned from (Exporter's name,
address and country)
 

ROHM AND HAAS VIET NAM CO., LTD

ASEAN TRADE IN GOODS AGREEMENT/

ROAD NO 5, NHON TRACH 3 INDUSTRIAL PARK, PHASE 2, NHON TRACH DIST,

ASEAN INDUSTRIAL COOPERATION SCHEME

DONG NAI PROVINCE VIET NAM

CERTIFICATE OF ORIGIN

VIET NAM
(Combined Declaration and Certificate)

2. Goods
Consigned to (Importer's/ Consignee's name, address, country) FORM D
CONNELL BROS CO (THAILAND) LTD

Issued in  VIET NAM

BB BLDG 18TH FL UNIT1802 NO 54, SUKHUMVIT 21, KLONGTOEY-NUEA,
(Country)
WATTANA BANGKOK 10110

THAILAND See Overleaf Notes

3. Means of transport and route (as far as known) 4. For Official Use

Departure Date: 23/03/2022

☐ Preferential Treatment Given Under ASEAN Trade in Goods Agreement

Vessel's name/Aircraft etc.:

WAN HAI 161 N428

☐ Preferential Treatment Given Under ASEAN Industrial Cooperation Scheme

Port of Discharge:
BANGKOK (THAILAND)

☐ Preferential Treatment Not Given (Please state reason/s)

..........................................................................................
Signature of Authorised Signatory of the Importing Country

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

1 CONNELL BROS CO PRIMAL TM AS-8000 EMULSION 200KG CTH 11,506.00 984012057

(THAILAND)LTD 211-40225 PLASTIC DRUM

KILOGRAM
DATE: 18/03/2022
OP 55 PACKAGE
11,000.00
HS CODE: 39069020
KILOGRAM

18,059.12 USD

2 CONNELL BROS CO PRIMAL TM AS-8098EF EMULSION 200KG CTH 5,220.00 984012057

(THAILAND) LTD211-40225 PLASTIC DRUM

KILOGRAM
DATE: 18/03/2022
OP 25 PACKAGE
5,000.00
HS CODE: 39069020
KILOGRAM

6,208.68 USD

11. Declaration by the exporter 12. Certification

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

VIET NAM
(country)
and that they comply with the origin requirements specified for those goods
in the
Generalised System of Preferences for goods exported to

THAILAND

(importing country)

DONG NAI, 24/03/2022

DONG NAI, 24/03/2022
Place and date, signature of authorised signatory
Place and date, signature and stamp of certifying authority
13.

Third Country Invoicing
Exhibition

Accumulation
De Minimis

Back-to-Back CO
Issued Retroactively

Partial Cumulation
Page 1 / 1


ROHM AND HAAS VIETNAM CO.,LTD.

039CX18548
ROAD NO 5, NHON TRACH 3 INDUSTRIAL

PARK PHASE 2.

NHON TRACH DIST, DONG NAI PROVINCE

VIETNAM.

CONNELL BROS CO (THAILAND) LTD

BB BLDG 18TH FL UNIT1802 NO 54

SUKHUMVIT 21 KLONGTOEY-NUEA

WATTANA BANGKOK 10110, THAILAND

ATTN: SAOWANEE.W@CONNELLWORLD.COM

CONNELL BROS CO (THAILAND) LTD

BB BLDG 18TH FL UNIT1802 NO 54

SUKHUMVIT 21 KLONGTOEY-NUEA

WATTANA BANGKOK 10110, THAILAND

WAN HAI LINES (THAILAND) LTD.

ATTN: SAOWANEE.W@CONNELLWORLD.COM 21FL LUMPINI TOWER 1168/56, 61 RAMA 4

ROAD THUNGMAHAMEK SATHORN

BANGKOK 10120 THAILAND

TEL : 4816100 FAX : 2856340

WAN HAI 161 N428

CAT LAI PORT HOCHIMINH,

CAT LAI PORT HOCHIMINH,

VIETNAM VIETNAM

BANGKOK, THAILAND BANGKOK, THAILAND

CONNELL BROS CO (THAILAND)

"SHIPPER'S PACK LOAD COUNT & SEAL"

16,726.000
LTD211-40225 OP
"SAID TO CONTAIN"
1 CTR KGS

PO: 113477877

(80
25.0000
FCL/FCL
PRIMAL TM AS-8000 EMULSION

PACKAGE(S)) CBM
DFSU3045363 20SD86 WHLP540645 200KG PLASTIC DRUM

55 PACKAGES=55 DR

PRIMAL TM AS-8098EF EMULSION

200 KG PLASTIC DRUM

25 PACKAGES=25 DR LOADED ON M/V

"FREIGHT PREPAID" WAN HAI 161
SAY : ONE CONTAINER ONLY VOY:N428
AT:CAT LAI PORT
HOCHIMINH,

VIETNAM
ON:MAR 23 2022

CAT LAI PORT HOCHIMINH ZERO (0) VIETNAM MAR 23 2022

ALL AS ARRANGED

WAN HAI ( VIETNAM ) LTD

MAR 23 2022
AS AGENT FOR THE CARRIER WAN HAI LINES LTD.
WAN HAI 161 N428

CAT LAI PORT HOCHIMINH, VIETNAM