Draft

P8/KI-D1/16.0/XI/2023/001206
Description of products :
No. Common Name Scientific Name Quantity Unit
1 FROZEN GROUPER FISH Chromileptes altivelis 2,802.00 KGM
2 FROZEN JENAHA FISH Lutjanus argentima culatus 201.50 KGM
3 FROZEN RED SNAPPER FISH Luntjanus sanguineus 1,289.00 KGM

TOTAL 4,292.50 KGM

1. Consignor / Pengirim Barang 2. Competent Authority

Name / Nama : REGIONAL FISH QUARANTINE AND INSPECTION
PT. SHINMAS JAYA BAHARI AGENCY (RFQIA) SURABAYA II
Address / Alamat :
Margomulyo Industri III Komplek Suri Mulia Blok H-17, Surabaya East Java - Indonesia +628113030333

3. Consignee / Penerima Barang

Name / Nama :
NSK TRADING SDN BHD
Address / Alamat :
LOT 4674, WISMA YAP TIEH, BATU 8, JALAN IPOH, SELAYANG 68100 BATU CAVES SELANGOR, MALAYSIA - Malaysia

4. √ Producing establishment / farm / Pabrik Pengolahan / budidaya Aquaculture establishment / Unit Usaha Pembudidayaan Ikan (UUPI) Others / Lainnya
Name / Nama : No. UPI / Establishment ID Number :
PT. SHINMAS JAYA BAHARI 065/PM/HACCP/PB/08/21
Address (Detailed) / Alamat Lengkap :
Margomulyo Industri III Komplek Suri Mulia Blok H-17, Surabaya East Java - Indonesia

5. Country and region of origin / Negara dan daerah asal : 6. Source / Sumber :
THE REPUBLIC OF INDONESIA, EAST JAVA Farm - Raised / Budidaya √ Wild - Caught / Tangkap

7. Port of shipment / Pelabuhan pengeluaran: 8. Means of transport / Alat transportasi :

TANJUNG PERAK, SURABAYA, INDONESIA Aeroplane / Angkutan udara √ Ship / Angkutan laut Road vehicle / Angkutan darat

9. Description of commodity / Deskripsi komoditas : 10. Temperature of the commodity / Temperatur komoditas :
FROZEN FISH Ambient (live) / √ Frozen / beku Chilled / dingin
ruang (hidup)

11. Commodities intended for uses as / komoditas diperuntukan sebagai : 12. Total number of packages, associated Batch number and number of
packages per batch / Jumlah kemasan total terkait nomor dan kemasan :
√ Human consumption / konsumsi manusia
113 Bag, 68 Carton
Culture / breeding (broodstock, eggs, gamates) / budidaya
Ornamental / ikan hias
Research & Isvestigation / Penelitian dan pemeriksaan
Aquatic animal feed / baits / pangan / umpan pancing
Non edible (fish skin, shell, bones, etc) *(information on batch see attachment if insufficient)

13. Type of packaging / Jenis kemasan : 14. Total quantity (kg) / Jumlah total (kg) :
Bag, Carton 4,292.50 KGM

15. Identification of container / seal number / Identifikasi Kontainer / nomor seal : 16. Port of destination / Pelabuhan tujuan :
CXRU 1341964 [ JKTA387857 ] WESTPORT/PORT KLANG, MALAYSIA

17. Identification of transport / Identitas alat transport : 18. Date of Departure / Tanggal pengiriman:
Name of Transportation / Nama Alat Angkut : CMA CGM LISBON November 19, 2023
Voyage Number / Nomor penerbangan : 1UE0QN1NC
19. Testing laboratory / Laboratorium penguji: Address / Alamat:

Approving officer name / Penanggungjawab laboratorium :

Testing report number / Nomor laporan hasil uji:

Signature / Tanda tangan: RICAT PAHLEVI HIDAYAT, S.ST.Pi, M.Si
Ref. Number : P8/KI-D1/16.0/XI/2023/001206 Draft No. NSW : P8KI-D116.0XI2023001206

Attestation

The undersigned Certifying Official certifies that the product(s) / Pejabat penandatangan sertifikat di bawah ini menyatakan bahwa produk :
Fin Fish / Ikan bersirip Mollusca / Moluska Crustacea / Krustasea Fishery Products / Produk perikanan Others / Lainnya
described above satisfy(s) the following requirements / yang diuraikan di atas memenuhi persyaratan berikut

√ a. The Product from each batch *) described above have been processed, inspected and graded in (an) establishment(s) that has been approved by and under control of the Competent
Authority / Produk tersebut di atas telah diproses, diinspeksi dan dinilai dalam kondisi yang telah disetujui oleh dan di bawah kendali Otoritas Kompeten

√ b. have been handled, prepared or processed, identified, stored and transported under a competent HACCP and sanitary programme consistently implemented and in accordance with
the requirements laid down in Codex Code of Practice for Fish and Fishery Products (CAC/RCP 52-2003) / telah ditangani, disiapkan atau diproses, diidentifikasi, disimpan dan
ditransportasikan sesuai persyaratan sanitasi dan HACCP yang diterapkan secara konsisten dan sesuai dengan persyaratan yang ditetapkan Codex Code of Practice for Fish
and Fishery Products (CAC / RCP 52-2003)
c. The Product from each batch *) has been found to be free of disease based on sampling and testing method recognized by the World Organisation for Animal Health (OIE) for
demonstrating absence of disease and inspected according to the appropiate procedures and subsequently found, at the time of inspection / Produk /dari setiap batch pasca
pengolahan bebas dari penyakit berdasarkan pengambilan sampel dan metode pengujian yang diakui oleh World Organisation for Animal Health (OIE) dan pada saat
pemeriksaan:
to be free from diseases / bebas dari penyakit: -----
to show no visible/ clinical signs of diseases / tidak menunjukkan gejala penyakit secara visual / klinis: All infectious diseases

d. For non edible products have been handled, prepared or processed, stored, transported based on biosecurity principles / produk non pangan telah ditangani, disiapkan atau
diproses, disimpan, ditransportasikan berdasarkan prinsip biosekuriti

Additional information / Information tambahan:

23. CERTIFIED DETAILS / Detail Penerbit Sertifikat Issued at SURABAYA, On November 17, 2023
Name / Nama : RICAT PAHLEVI HIDAYAT, S.ST.Pi, M.Si Certifiying Body : REGIONAL FISH QUARANTINE AND INSPECTION
Position / Posisi : Inspector AGENCY (RFQIA) SURABAYA II
Issued at / Lokasi : Indonesia, SURABAYA
Phone / Telepon : +62313283886 Stamp / Stampel

Fax / Faksimili : -
E-mail / Surat Elektronik : perak@bkipm.kkp.go.id
Address / Alamat : JALAN KALIMAS BARU NO. 86, SURABAYA, Indonesia

Signature / Tanda tangan RICAT PAHLEVI HIDAYAT, S.ST.Pi, M.Si

Name of Official / Inspector