12191501356

1. Goods consigned from (Export's business name, address, country).

PT LANGGENG BUANA JAYA

JL. RAYA VETERAN MADYA NO. 8, GENDING, KEBOMAS, GRESIK, JAWA TIMUR
INDONESIA

MINISTRY OF TRADE
2. Goods consigned to (Consignee's name, address, country).
OF THE REPUBLIC OF INDONESIA
GROBABY CC CERTIFICATE OF ORIGIN
12, ARBEID AVENUE
STRIJDOM PARK FORM B
RANDBURG,2194
JOHANNESBURG,SOUTH AFRICA

Reference No. 0000411/GRS/2024

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

Shipped By : SINAR SIANTAR 035N ISSUED RETROSPECTIVELY

From : SURABAYA (PTT)

To : DURBAN

Date of Shipment : JANUARY 03, 2024

5. item 6. Marks and numbers 7. Number and kind of packages; description of goods. 8. Gross weight or 9. Number and
num- of packages other quantity date of invoices
ber.

1 IMPORTED AND SHIPPED BY 67 CARTONS OF 1608 PCS OF BABY PRODUCTS 1,608.0000 PCE 634/EXP.LBJ/1223
GRO BABY PO#GRO2023-09 GW: DECEMBER 26, 2023
12 ARBEID 369.1700 KGM
AVENUE,STRIJDOM PARK,
RANDBURG,2194 67 CT
SOUTH AFRICA ITEM#9019601/ 4PK OCEAN SQUIRTERS (EU) / 67 CTNS / 1608 PCS
ITEM# HS: 950300
QTY: PCS
MADE IN INDONESIA

10. Certification.

It is hereby certified, on the basis of control carried out, that the goods stated above were produced in Indonesia

GRESIK, JANUARY 11, 2024

11. Competent authority (name, full address).

ISSUING OFFICE IN KABUPATEN GRESIK
JL. DR. WAHIDIN SUDIROHUSODO NO. 245, GRESIK, JAWA
TIMUR

YOEDI SETIYONO

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