No.

REPUBLIC OF INDONESIA
MINISTRY OF AGRICULTURE
INDONESIAN AGRICULTURAL QUARANTINE AGENCY
KT - 10

PHYTOSANITARY CERTIFICATE Plant Protection Organization of Indonesia

DRAFT DRAFT
No.: ...................................................... to: Plant Protection Organization(s) of.
CHINA
..............................................................................
I. DESCRIPTION OF CONSIGNMENT
Name and address of exporter: Declared name and address of consignee:
PT. SUPER HOME PRODUCT INDONESIA YANGZHOU FUSHIDA BRUSHES CO., LTD
DUSUN BARU RT 03 SUNGAI BULUH KECAMATAN MUARA GUOCUN TOWN, JIANGDU, YANGZHOU, JIANGSU CHINA
BULIAN KABUPATEN BATANG HARI

Declared means of conveyance: Declared point of entry:

MARITIME TRANSPORT SUMBER JAYA 2515 WAIGAOQIAO, CHINA
S292N
HS Code: Place of Origin:
44170090 JAMBI

Distinguishing marks: Number and description of packages, name of produce, Quantity Declared:
BRUSH BODY botanical name of plants:
1. BRUSH BODY 224 Package 8,442.00 kilograms
HEVEA BRASILIENSIS
Number of Commodities: 1 Total: 8,442.00 kilograms

II. ADDITIONAL DECLARATION III. DISINFESTATION AND/OR DISINFECTION TREATMENT

=== NONE === Treatment Date
=== NONE === === NONE ===

Chemical (active ingredient) Concentration

=== NONE === === NONE ===

Duration and Temperature

=== NONE ===

Additional Information
=== NONE ===

This is to certify that the plants or plant products or other regulated articles described herein:
- have been inspected and/or tested according to appropriate official procedures and
- are considered to be free from the quarantine pests specified by the importing contracting party and
- to conform with the current phytosanitary requirements of the importing contracting party, including those for
regulated non-quarantine pests.

Name of LIDYA
authorized officer:
Place of issue: JAMBI, INDONESIA

Date of issue: MARCH 31, 2022

(Signature) (Stamp of Organization)
No financial liability with respect to this certificate shall attach to Plant Quarantine Service of Indonesia or to any of its officers or
representatives.

Printed 31/03/2022 15:05:11 - IQFAST v.4.3.2