Professional Documents
Culture Documents
1. Goods consigned from (Exporter's business name, address, country) Reference No. 0025295/KTG/2017
PT. POLYMINDO PERMATA
KOMP. KEDOYA ELOK PLAZA BLOK DC NO. 54 KEDOYA SELATAN KEBON
JERUK JAKARTA BARAT DKI JAKARTA 11520
ASEAN TRADE IN GOODS AGREEMENT
INDONESIA ASEAN INDUSTRIAL COOPERATION SCHEME
CERTIFICATE OF ORIGIN
2. Goods consigned to (Consignee's name, address, country) (Combined Declaration and Certificate)
GIA MAN CO., LTD FORM D
113TTH07, QUARTER 3, TAN THOI HIEP WARD, DITRICT 12, HO CHI MINH CITY, Issued in INDONESIA
VIET NAM TEL: +84 903033777 ATTN :TRAN VAN TRI (Country)
VIET NAM
See Overleaf Notes
3. Means of transport and route (as far as known) 4. For Official Use
5. Item 6. Marks and numbers 7. Number and type of packages, description 8. Origin criterion 9. Gross weight or other 10. Number and
number on packages of goods (including quantity where (see Overleaf Notes) Quantity and Value date of
appropriate (FOB) where RVC is Invoices
and HS number of the importing country) applied
1 GIA MAN CO., LTD 52 SACKS OF VIRO SYNTHETIC FIBER RVC 85.77% GW : VR-055/VII/17
INVOICE NO: VR-055/VII/17 1,534.14 KGM JULY 21, 2017
HS: 3916.90 NW :
1,526.86 KGM
USD 6,527.33
(SIX THOUSAND FIVE
HUNDRED AND
TWENTY-SEVEN POINT
THIRTY-THREE)
INDONESIA
MUNICIPALITY OFFICE IN TANGERANG
......................................................................................................................
(Country)
and that they comply with the origin requirements specified for
these goods in the ASEAN Trade in Goods Agreement for the goods
exported to
VIET NAM
......................................................................................................................
(Importing Country)
13.
Third Country Invoicing Exhibition
Page 1 / 1