CERTIFICATE OF ORIGIN

1. Goods consigned from (exporter’s

business name, address, country)
GENERALIZED SYSTEM OF
PT. Agung Perkasa PREFERENCES
Jl. Jend Sudirman Kav 55, Jakarta, CERTIFICATE OF ORIGIN
Indonesia. (Combined declaration and certificate)
2. Goods consigned to (consignee’s
name, address, country) FORM A
Issued in INDONESIA
Hubberd Trading Ltd. (country)
PO Box 4816, London, England.

3. Means of trsnsport and route (as far 4. For official use

as known)
SHIPPED BY : SEA
FROM : JAKARTA / INDONESIA
TO : LONDON / ENGLAND
DATE OF : April 1 2024
SHIPMENT

5. Item 6. Marks and 7. Number and 8. Origin 9. Weight or 10. Number

Num- numbers kind of criterion other and date
Ber of packages; (see quantitiy of
packages description of notes invoices
goods overleaf)

1 HUBBERD “P” 250 Metric 895/ASMI/I/01

LONDON 5000 Guny bag Tons April 1, 2024
White Pepper

11. Certification 12. Declaration by the exporter

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

ENGLAND (importing country)

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