Triplicate

1.Products consigned from(Exporter’s business name,address, Reference No.

country)
HANGZHOU XIAOWEI TECHNOLOGY CO. , LTD.
ROOM 158, BUILDING 1, LINGLONG COUNTY, NO.581, SOUTH ASEAN-CHINA FREE TRADE AREA
FU ROAD,JIANGNAN TOWN,TONGLU COUNTY,HANGZHOU CITY,
ZHEJIANG PROVINCE,CHINA PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
PT YIH QUAN FOOTWEAR INDONESIA FORM E
KAVELING III-14, III-18, III-19, III-20, 非有效证书
DESA KEDAWUNG, KEC. BANYUPUTIH,KAB. BATANG, JAWA
TENGAH, KODE POS : 51271 Issued in THE PEOPLE'S REPUBLIC OF CHINA
TAX ID : 43.372.268.3-501.000 (Country)
TEL : +62(0)81342120818 * See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Verification:origin.customs.gov.cn
Departure date APR 07,2024 □ Preferential Treatment Given

Vessel's name/Aircraft etc.

Port of Discharge SEMARANG,INDONESIA

□ Preferential Treatment Not Given(Please state reason/s)

FROM SHEKOU,CHINA TO SEMARANG,INDONESIA

--------------------------------------------------------
Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on of products (including quantity where (see Overleaf weight or other quantity, date of
packages appropriate and HS number in six digit code) Notes) and value (FOB) only lnvoices
when RVC criterion is
applied
1 TWENTY FOUR (24)PACKAGES OF "PE" QA240403-1S
RUBBER BELT CONVEYOR 1SET APR.03,2024
PT YIH QUAN AI-702-6.5M-0.64-0.2
FOOTWEAR HS CODE:8477.10
2 INDONESIA 4SETS
"PE"
C/NO: CURVE CONVEYOR
MADE IN CHINA AI-702-PVC-T-R
3 HS CODE:8477.10
"PE"
EFFICIENT V-C HEAT SETTING MACHINE 1SET
AI-928VS
4
HS CODE:8514.39 "PE" 1SET
RUBBER BELT CONVEYOR
AI-702-3.7M-0.64-0.2
HS CODE:8477.10 1SET
5 "PE"
TWO-LAYER N.I.R. LIGHTS CEMENT DRYING &
ACTIVATING MACHINE
AI-868A-16.1M
HS CODE:8514.39 "PE" 3SETS
6
AIR PURIFIER
AI-8A8-2HP
HS CODE:8514.39 "PE" 2PIECES
7
SUCTION HOOD(INCLUDING COVERGLASS)
AI-70A-8-0.7M
HS CODE:8514.39
11.Declaration by the exporter 12.Certification
The undersigned hereby declares that the above details
it is hereby certified on the basis of control carried out,that the
and Statement are correct,that all the products were produced in
declaration by the exporter is correct
CHINA
-------------------------------------------------
(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

---------------------------------------------
(Importing Country)

---------------------------------------------
Place and date，signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority
 Triplicate
1.Products consigned from(Exporter’s business name,address, Reference No.
country)

**************************** ASEAN-CHINA FREE TRADE AREA

PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
FORM E
非有效证书
****************************
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Verification:origin.customs.gov.cn
Departure date □ Preferential Treatment Given

Vessel's name/Aircraft etc.

Port of Discharge
************* □ Preferential Treatment Not Given(Please state reason/s)

--------------------------------------------------------
Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on of products (including quantity where (see Overleaf weight or other quantity, date of
packages appropriate and HS number in six digit code) Notes) and value (FOB) only lnvoices
when RVC criterion is
applied
8 SUCTION HOOD(INCLUDING COVERGLASS) "PE" 4PIECES
AI-70A-8-2.8M
HS CODE:8514.39
9 SINGLE-LAYER N.I.R. LIGHTS OVEN "PE" 1SET
AI-818HA-1M-0.6
HS CODE:8514.39
10 VERTICAL TYPE SINGLE ROTARY REFRIGERATING "PE" 1SET
MACHINE
AI-728VS2
HS CODE:8453.20
"PE" 2SETS
11 RUBBER BELT CONVEYOR
AI-702-3M-0.64-0.2
HS CODE:8477.10
"PE" 1SET
12 RUBBER BELT CONVEYOR
AI-702-7.5M-0.64-0.2
HS CODE:8477.10
13 DISINFECTING DRYING OVEN "PE" 1SET
AI-743N
HS CODE:8514.39

11.Declaration by the exporter 12.Certification

The undersigned hereby declares that the above details
it is hereby certified on the basis of control carried out,that the
and Statement are correct,that all the products were produced in
declaration by the exporter is correct
CHINA
-------------------------------------------------
(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

---------------------------------------------
(Importing Country)

---------------------------------------------
Place and date，signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority
 Triplicate
1.Products consigned from(Exporter’s business name,address, Reference No.
country)

**************************** ASEAN-CHINA FREE TRADE AREA

PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
FORM E
非有效证书
****************************
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Verification:origin.customs.gov.cn
Departure date □ Preferential Treatment Given

Vessel's name/Aircraft etc.

Port of Discharge
************* □ Preferential Treatment Not Given(Please state reason/s)

--------------------------------------------------------
Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on of products (including quantity where (see Overleaf weight or other quantity, date of
packages appropriate and HS number in six digit code) Notes) and value (FOB) only lnvoices
when RVC criterion is
applied
14 AUTOMATIC SPRAY MOULD PROOF TRUNK "PE" 1SET
AI-740K
HS CODE:8453.20

15 MULTI-FUNCTION TEMPERATURE MANAGEMENT AND 1SET

RECORDING SYSTEM "PE"
AI-MRS-R
HS CODE:8514.39
16 1SET
ENERGY / CO2 CONSUMPTION MODULE "PE"
AI-MRS-RE
HS CODE:8514.39
17 8SETS
DISPLAY SCREEN "PE"
1B4-10-111
HS CODE:8514.39
18 2SETS
RUBBER BELT CONVEYOR "PE"
AI-702-12M-0.76-0.24
HS CODE:8477.10

11.Declaration by the exporter 12.Certification

The undersigned hereby declares that the above details it is hereby certified on the basis of control carried out,that the
and Statement are correct,that all the products were produced in declaration by the exporter is correct
CHINA
-------------------------------------------------
(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

---------------------------------------------
(Importing Country)

---------------------------------------------
Place and date，signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority
 Triplicate
1.Products consigned from(Exporter’s business name,address, Reference No.
country)
***
ASEAN-CHINA FREE TRADE AREA
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
*** FORM E
非有效证书
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Verification:origin.customs.gov.cn
Departure date □ Preferential Treatment Given

Vessel's name/Aircraft etc.

Port of Discharge
□ Preferential Treatment Not Given(Please state reason/s)

--------------------------------------------------------
Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on of products (including quantity where (see Overleaf weight or other quantity, date of
packages appropriate and HS number in six digit code) Notes) and value (FOB) only lnvoices
when RVC criterion is
applied
24 PACKAGES=36 NIU(36SETS)
GROSS WEIGHT: 13865 GS

* EMAIL : joanna.ts5168@gmail.com;
joanna_tsai168@yihquan.co.id;
bayu_riyadi025@yihquan.co.id;
debora_ivone888@yihquan.co.id;
aditya_prianggoro2023@yihquan.co.id;
exim@yihquan.co.id

TOTAL:TWENTY FOUR (24)PACKAGES ONLY.*

** *** *** ***
THIRD-PARTY OPERATOR：
CHEER ACCESS LTD.
SUITE 309, CAPITAL CITY BUILDING,
INDEPENDENCE AVENUE, VICTORIA,
MAHE, REPUBLIC OF SEYCHELLES

11.Declaration by the exporter 12.Certification

The undersigned hereby declares that the above details
it is hereby certified on the basis of control carried out,that the
and Statement are correct,that all the products were produced in
declaration by the exporter is correct
CHINA
-------------------------------------------------
(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

---------------------------------------------
(Importing Country)

---------------------------------------------
Place and date，signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority