PT POS INDONESIA (Persero) CUSTOMS DECLARATION CN 23

From Sender customs reference No. of item (barcode, if

Name : FAIRUZ FADIYAH NIK-6471035508030005 | Maybe opened officially
De any)
Address : KOMP WIRAPRATAMA I E 2 RT044 RW008 DECLARATION EN DOUANE
No. of item (barcode, if | Maybe opened officially
Address (count)
any)
Postcode : 70712 City : KOTA BANJARBARU
State KALIMANTAN SELATAN Country : ID-INDONESIA Declaration ID
To Name : CELIA RODRIGUES C D S 0 4 2 3 1 5 7 7 3 6
A
Address : 6750 CLARK MONTREAL QUEBEC H25 3E9 CANADA Importer's references (if any) {tax code/VAT No./importer code) (optional)
Address (count)
Postcode H2S3E9 City MONTREAL 104687 Importer's telephone/fax/email (if known)
State CANADA Country CA-CANADA 5142423980 CELIARODRIGUES@GMAIL.COM

Net weight (3) For commersial item only

Detailed description of contents (1) Quantity (2) Total weight (4) Value (5) Total Value (6)
(in kg) HS tarif number (7) Country of origin of goods (8)
Printed Pictures 1 0,1 0,1 12.75 USD 12.75 USD 491191
Category of item (10) Sales of goods Commercial sample Office origin/Date of posting
Gift Returned Goods X Other
05/04/2023 07:06
Documents Mixed content
Comments (11) : (e.g goods subject to quarantine, sanitary/phytosanitary inspection or other restriction) I certify that the particulars given in this custom
declaration are correct and that this item does not
contain any dangerous article or articles prohibited by
legisation or by postal or customs regulations
Licence (12) Certificate (13) Invoice (14) Date and sender's signature (15)
No(s). of licence(s) No(s). of certificate(s) No(s). of invoice 05/04/2023 07:06