1. Goods consigned from (exporter's business name, address, country) Reference No.

PT CORT INDONESIA
KAWASAN BERIKAT NIP BLOK G-5,6
MOJOKERTO,61385 JAWA TIMUR
INDONESIA GENERALIZED SYSTEM OF PREFERENCES

CERTIFICATE OF ORIGIN

(Combined declaration and certificate)

2. Goods consigned to (consignee's name, address, country)

FENDER MUSICAL INSTRUMENTS CORP. FORM A

1295 EAST CENTRAL AVENUE
SAN BERNARDINO, CA 92408 U.S.A. Issued in INDONESIA

(country)

See notes overleaf

3. Means of transport and route (as far as known) 4. For official use

SHIPPED BY : X-PRESS ODYSSEY V.0XL3GN

FROM : SURABAYA, INDONESIA

TO : LOS ANGELES, U.S.A

DATE OF SHIPMENT : AUGUST 28, 2023

5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
num- numbers of criterion or other and date
ber packages (see Notes quantity of invoices
Overleaf)

1 FENDER 1411 CTNS = 1411 PCS OF MUSICAL INSTRUMENTS Y 53.00% 6,743.8400 KGM CTI23081353,-1
SAN -2,-3,-4,-5,-6
BERNARDINO,CA 1411 PCS OF ELECTRIC GUITARS/BASS AUGUST 24,
VIA LONG BEACH 2023
C/#.1-2, 1-50,
1-439,
1-103, 1-13, 1-754,
1-50
MADE IN
INDONESIA,
CHINA,
USA

11. Certification 12. Declaration by the exporter

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

ISSUING OFFICE IN PROVINSI JAWA TIMUR produced in INDONESIA

(country)

and that they comply with the origin requirements specified for those goods
in the generalized system of preferences for goods exported to

UNITED STATES OF AMERICA

(importing country)

SURABAYA, MOJOKERTO,
Place and date, signature of authorized signatory
Place and date, signature and stamp of certifying authority

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