1. Products consigned from (Exporter's business name, address, country) Reference No.

-
PT CORT INDONESIA ASEAN-CHINA FREE TRADE AREA
KAWASAN BERIKAT NIP BLOK G-5,6 PREFERENTIAL TARIFF
MOJOKERTO,61385 JAWA TIMUR CERTIFICATE OF ORIGIN
INDONESIA (Combined Declaration and Certificate)

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

GUANGZHOU TAIZHI IMPORT AND EXPORT TRADING CO., LTD.
306B/FL, RISHENG BUILDING, NO. 35
Issued in INDONESIA
QINGCAI EAST STREET, HUALE ROAD, GUANGZHOU,
510060, CHINA See Overleaf Notes

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

Departure Date AUGUST 22, 2023

Preferential Treatment Given

Vessel's name/Aircraft etc. YM HAWK V.329W

Preferential Treatment Not Given (Please State reason/s)

Port of Discharge GUANGZHOU

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 FENDER 596CTNS = 546 PCE & 50 PCE OF CTH 376.000 PCE CTI23071161,-1,-2,-13
CHINA MUSICAL INSTRUMENTS AND AUGUST 21, 2023
C/NO.1-424; 1-111; AMPLIFIERS
1-50; 1-11 FENDER INVOICE NO.
MADE IN INDONESIA 5 PCS OF ELECTRIC GUITAR 96831639 96830212
FINGERBOARD 96830213 96830214
CONTAIN DALBERGIA LATIFOLIA AUGUST 22, 2023
0.0016695 CBM, ORIGIN: INDIA

ELECTRIC GUITAR
HS: 920790

2 ELECTRIC BASS CTH 159.000 PCE CTI23071161,-1,-2,-13

HS: 920790 AUGUST 21, 2023

FENDER INVOICE NO.

96831639 96830212
96830213 96830214
AUGUST 22, 2023
3 GUITAR COMBO AMPLIFIER CTH 50.000 PCE CTI23071161,-1,-2,-13
HS: 851821 AUGUST 21, 2023

FENDER INVOICE NO.

96831639 96830212
96830213 96830214
AUGUST 22, 2023

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)

MOJOKERTO, -
Place and date, signature of authorized signatory

13. Issued Retroactively Exhibition

Movement Certificate v 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 CORT INDONESIA ASEAN-CHINA FREE TRADE AREA
KAWASAN BERIKAT NIP BLOK G-5,6 PREFERENTIAL TARIFF
MOJOKERTO,61385 JAWA TIMUR CERTIFICATE OF ORIGIN
INDONESIA (Combined Declaration and Certificate)

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

GUANGZHOU TAIZHI IMPORT AND EXPORT TRADING CO., LTD.
306B/FL, RISHENG BUILDING, NO. 35
Issued in INDONESIA
QINGCAI EAST STREET, HUALE ROAD, GUANGZHOU,
510060, CHINA See Overleaf Notes

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

Departure Date AUGUST 22, 2023

Preferential Treatment Given

Vessel's name/Aircraft etc. YM HAWK V.329W

Preferential Treatment Not Given (Please State reason/s)

Port of Discharge GUANGZHOU

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
4 ELECTRIC GUITAR CTH 5.000 PCE CTI23071161,-1,-2,-13
HS: 920790 AUGUST 21, 2023

FENDER INVOICE NO.

96831639 96830212
96830213 96830214
AUGUST 22, 2023
5 ELECTRIC GUITAR CTH 6.000 PCE CTI23071161,-1,-2,-13
HS: 920790 AUGUST 21, 2023

FENDER MUSICAL INSTRUMENTS CORP FENDER INVOICE NO.

17600 NORTH PERIMETER DRIVE 96831639 96830212
SUITE 100 SCOTTDALE, AZ. 85255 96830213 96830214
UNITED STATES OF AMERICA AUGUST 22, 2023

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)

MOJOKERTO, -
Place and date, signature of authorized signatory

13. Issued Retroactively Exhibition

Movement Certificate v Third Party Invoicing SURABAYA, -

Place and date, signature and stamp of certifying authority

Page 2 / 2