ROHM AND HAAS VIETNAM CO., LTD.

039CX69133
ROAD NO 5, NHON TRACH 3 INDUSTRIAL

PARK PHASE 2.

NHON TRACH DIST, DONG NAI PROVINCE

VIETNAM.

CONNELL BROS. COMPANY (MALAYSIA) SDN

. BHD.

NO. 6 JALAN KONTRAKTOR U1/14,

HICOM GLENMARIE INDUSTRIAL PK

40150 SHAH ALAM SELANGOR DARUL EHSAN

MALAYSIA

SAME AS CONSIGNEE

WAN HAI LINES (M) SDN BHD

#01-16, #02-16, JALAN MOLEK 1/31

TAMAN MOLEK, 81100 JOHOR BAHRU, JOHOR

TEL : 3608000 FAX : 3557621

CAPE FLINT S019

CAT LAI PORT HOCHIMINH,

CAT LAI PORT HOCHIMINH,

VIETNAM VIETNAM

PASIR GUDANG,JOHOR, MALAYSIA PASIR GUDANG,JOHOR, MALAYSIA

CONNELL BROS COMPANY (M) SD

"SHIPPER'S PACK LOAD COUNT & SEAL"

16,976.000
N BHDPO# 213-37948 OD
"SAID TO CONTAIN"
1 CTR KGS

PRIMAL TM MC-76LO EMULSION

(16
25.0000
FCL/FCL
1000KG IBC

PACKAGE(S)) CBM
WHSU2859619 20SD86 WHLR265804 PO: 0114190916

16 PACKAGES = 16 IBC
"FREIGHT PREPAID"
SAY : ONE CONTAINER ONLY
LOADED ON M/V
CAPE FLINT
VOY:S019
AT:CAT LAI PORT
HOCHIMINH,

VIETNAM
ON:SEP 20 2022

CAT LAI PORT HOCHIMINH ZERO (0) VIETNAM SEP 20 2022

ALL AS ARRANGED

WAN HAI ( VIETNAM ) LTD

SEP 20 2022
AS AGENT FOR THE CARRIER WAN HAI LINES LTD.
CAPE FLINT S019

CAT LAI PORT HOCHIMINH, VIETNAM

 Reference No.  
VN-MY 22/04/19172
1. Goods Consigned from (Exporter's name,
address and country)
 

ROHM AND HAAS VIET NAM CO., LTD

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

ASEAN TRADE IN GOODS AGREEMENT

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. COMPANY (MALAYSIA) SDN. BHD

Issued in  VIET NAM

NO. 6 JALAN KONTRAKTOR U1/14, HICOM GLENMARIE INDUSTRIAL PARK,
(Country)
40150 SHAH ALAM, SELANGOR DARUL EHSAN

MALAYSIA See Overleaf Notes

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

Departure Date: 20/09/2022

☐ Preferential Treatment Given Under ASEAN Trade in Goods Agreement

Vessel's name/Aircraft etc.:

CAPE FLINT S019

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

Port of Discharge:
PASIR GUDANG - JOHOR (MALAYSIA)

..........................................................................................
Signature of Authorised Signatory of the Customs Authority 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 PRIMAL TM MC-76LO EMULSION 1000KG IBC

CTH 16,976.00 984235293

COMPANY (M) SDN 16 PACKAGE

KILOGRAM
DATE: 16/09/2022
BHDPO# 213-37948 OD HS CODE: 39069020
16,000.00
KILOGRAM

29,941.80 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 these goods in the
ASEAN Trade in Goods Agreement for the goods exported to

MALAYSIA

(Importing country)

DONG NAI, 21/09/2022

DONG NAI, 21/09/2022
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
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