kurang titik ALAMAT SALAH

1. Products consigned from (Exporter's business name, address, country) Reference No. -
PT ANUGRAH LAUT INDONESIA ASEAN-CHINA FREE TRADE AREA
JALAN IKAN PIRANHA NOMOR 22 PERUM TAMBAKREJO, TAMBAKREJO, PREFERENTIAL TARIFF
WARU, SIDOARJO, JAWA TIMUR CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)

2. Goods consigned to (Consignee's name, address, country) FORM E

WENZHOU GUANLONGKAI INTERNATIONAL TRADING CO.,LTD
SOUTH HEAD OF ROOM 1509, BUILDING 2, OUHAI NIUSHAN SQUARE,
Issued in INDONESIA
NO.1,3,5, DONGANHUA ROAD, XINQIAO STREET, OUHAI DISTRICT,
WENZHOU CITY, ZHEJIANG PROVINCE.CHINA ZHEKIANG See Overleaf Notes
USCI NO:91330302MA7ETTKH68

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

Departure Date JANUARY 01, 2023

Preferential Treatment Given

Vessel's name/Aircraft etc. WAN HAI 315 V. N210

Preferential Treatment Not Given (Please State reason/s)

Port of Discharge MAWEI, FUZHOU, CHINA

Signature of Authorised Signatory of the Importing Party

5. Item 6. Marks and numbers 7. Number and type of packages, 8. Origin criteria 9. Gross weight 10. Number,
number of packages description of products (including (see Overleaf Notes) or net weight or date of Invoices
quantity where appropriate other quantity and
and HS number in six digit code) value (FOB) only
when RVC
criterion is applied
1 CONTAINER AND 96 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022
SEAL NO : FROZEN CUTTLEFISH 1,008.0000 KGM JANUARY 27, 2023
SEGU 9555375 / HS: 030743 NW:
WHLT 666460 940.8000 KGM 27 DECEMBER 2022
USD 1,975.6800

2 81 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022

FROZEN CUTTLEFISH 850.5000 KGM JANUARY 27, 2023
HS: 030743 NW:
793.8000 KGM 27 DECEMBER 2022
USD 2,063.8800

3 25 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022

FROZEN CUTTLEFISH 262.5000 KGM JANUARY 27, 2023
HS: 030743 NW:
245.0000 KGM 27 DECEMBER 2022
USD 857.5000

4 3 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022

FROZEN CUTTLEFISH 31.5000 KGM JANUARY 27, 2023
HS: 030743 NW:
29.4000 KGM 27 DECEMBER 2022
USD 108.7800

5 608 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022

FROZEN HEADLESS RED BIG EYE FISH 6,080.0000 KGM JANUARY 27, 2023
HS: 030389 USD 6,019.2000
27 DECEMBER 2022

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 by
are correct; that all the products were produced in the exporter is correct.

INDONESIA ISSUING OFFICE IN PROVINSI JAWA TIMUR

(Country)
and that they comply with the origin requirements specified for these
Products in the Rules of Origin for the ACFTA for the products
exported to

CHINA
(Importing Country)

SIDOARJO, -
Place and date, signature of authorized signatory

13. Issued Retroactively Exhibition

Movement Certificate Third Party Invoicing SURABAYA, -

Place and date, signature and stamp of certifying authority

Page 1 / 2
 1. Products consigned from (Exporter's business name, address, country) Reference No. -
PT ANUGRAH LAUT INDONESIA ASEAN-CHINA FREE TRADE AREA
JALAN IKAN PIRANHA NOMOR 22 PERUM TAMBAKREJO, TAMBAKREJO, PREFERENTIAL TARIFF
WARU, SIDOARJO, JAWA TIMUR CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)

2. Goods consigned to (Consignee's name, address, country) FORM E

WENZHOU GUANLONGKAI INTERNATIONAL TRADING CO.,LTD
SOUTH HEAD OF ROOM 1509, BUILDING 2, OUHAI NIUSHAN SQUARE,
Issued in INDONESIA
NO.1,3,5, DONGANHUA ROAD, XINQIAO STREET, OUHAI DISTRICT,
WENZHOU CITY, ZHEJIANG PROVINCE.CHINA See Overleaf Notes
USCI NO:91330302MA7ETTKH68

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

Departure Date JANUARY 01, 2023

Preferential Treatment Given

Vessel's name/Aircraft etc. WAN HAI 315 V. N210

Preferential Treatment Not Given (Please State reason/s)

Port of Discharge MAWEI, FUZHOU, CHINA

Signature of Authorised Signatory of the Importing Party

5. Item 6. Marks and numbers 7. Number and type of packages, 8. Origin criteria 9. Gross weight 10. Number,
number of packages description of products (including (see Overleaf Notes) or net weight or date of Invoices
quantity where appropriate other quantity and
and HS number in six digit code) value (FOB) only
when RVC
criterion is applied
6 1872 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022
FROZEN HEADLESS RED BIG EYE FISH 18,720.0000 KGM JANUARY 27, 2023
HS: 030389 USD 21,902.4000
27 DECEMBER 2022

7 214 CARTONS OF WO GW: 349/PL-EXP/ALI/XII/2022

FROZEN HEADLESS RED BIG EYE FISH 2,140.0000 KGM JANUARY 27, 2023
HS: 030389 NW:
1,926.0000 KGM
27 DECEMBER 2022
USD 2,889.0000

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 by
are correct; that all the products were produced in the exporter is correct.

INDONESIA ISSUING OFFICE IN PROVINSI JAWA TIMUR

(Country)
and that they comply with the origin requirements specified for these
Products in the Rules of Origin for the ACFTA for the products
exported to

CHINA
(Importing Country)

SIDOARJO, -
Place and date, signature of authorized signatory

13. Issued Retroactively Exhibition

Movement Certificate Third Party Invoicing SURABAYA, -

Place and date, signature and stamp of certifying authority

Page 2 / 2