No.

REPUBLIC OF INDONESIA
MINISTRY OF AGRICULTURE
KT - 10 INDONESIAN AGRICULTURAL QUARANTINE AGENCY

PHYTOSANITARY CERTIFICATE Plant Protection Organization of Indonesia

No.: .D...R...A....F..T....D...R....A...F...T........................ to: Plant Protection Organization(s) of.
.V I E T N A M.............................................................
I. DESCRIPTION OF CONSIGNMENT
Name and address of exporter: Declared name and address of consignee:
PT. OLAM INDONESIA LONG BINH BRANCH OF OLAM VIETNAM LIMITED,
SOUTH QUARTER TOWER A, LANTAI 21, UNIT A,G,H
JL.R.A KARTINI KAV. 8 JAKARTA SELATAN, INDONESIA LOT E05, LONG BINH INDUSTRIAL PARK, LONG
BINH WARD BIEN HOA CITY, DONG NAI
PROVINCE, VIETNAM, TAX CODE: 6000346337-009

Declared means of conveyance: Declared point of entry:

MARITIM TRANSPORT MERATUS JIMBARAN V. 309N HO CHI MINH, VIETNAM

HS Code: Place of Origin:

- PANJANG, INDONESIA

Distinguishing marks: Number and description of packages, name of produce, Quantity Declared:
OLAM#6600116294 botanical name of plants:
1. 38,278 KGS INDONESIA WHITE PEPPER 52,262.00 kilograms
WHITE PEPPER 13,984 KGS INDONESIA BLACK PEPPER RAW
Total: 52,262.00 kilograms
NET WT: 59.80 KG
Piper nigrum
SUPPLIER : PT. HS CODE : 0904.11.10 & 0904.11.20
OLAM INDONESIA Number of Commodities: 1
ORIGIN :
INDONESIA
HARVEST CROP :
DEC 2022

II. ADDITIONAL DECLARATION III. DISINFESTATION AND/OR DISINFECTION TREATMENT

BL NUMBER : 225494318 Treatment Date
=== NONE === === NONE ===
OLAM#6600116294
BLACK PEPPER RAW Chemical (active ingredient) Concentration
NET WT: 67.23 KG === NONE === === NONE ===
SUPPLIER : PT. OLAM INDONESIA
Duration and Temperature
ORIGIN : INDONESIA === NONE ===
HARVEST CROP : JAN 2023
Additional Information
=== NONE ===
This is to certify that the plants or plant products or other regulated articles described herein:
- have been inspected and/or tested according to appropriate official procedures and
- are considered to be free from the quarantine pests specified by the importing contracting party and
- to conform with the current phytosanitary requirements of the importing contracting party, including those for
regulated non-quarantine pests.

Name of
authorized officer:
Place of issue: BANDAR LAMPUNG

Date of issue: MARCH, 2023

(Signature) (Stamp of Organization)
No financial liability with respect to this certificate shall attach to Plant Quarantine Service of Indonesia or to any of its officers or
representatives.

rinted 12/04/2021 14:31:26 - IQFAST v.4.0