65883984811

1. Goods Consigned from (Exporter's name, address and country) Certificate No. 0039351/KTG/2017 Form AANZ
PT. INDAH KIAT PULP & PAPER TBK.
SINAR MAS LAND PLAZA, MENARA 2, AGREEMENT ESTABLISHING THE ASEAN -
7TH FLOOR JL. M.H. THAMRIN NO. 51,
JAKARTA 10350, INDONESIA
AUSTRALIA - NEW ZEALAND FREE TRADE AREA (AANZFTA)

CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)
2. Goods Consigned to (Importer's/Cosignee's name, address, country)
Issued in INDONESIA
BJ BALL LIMITED (Country)
121 HUGO JOHNSTON DRIVE
PENROSE AUCKLAND 1061
TELEPHONE NUMBER : 6495790059 (see Overleaf Notes)

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

Preferential Treatment Given Under AANZFTA

Shipment Date NOVEMBER 19, 2017

Preferential Treatment Not Given (Please state reason/s)

Vessel's name/Aircraft etc. SEA

Port of Discharge AUCKLAND, NEW ZEALAND

.........................................................................................................
Signature of Authorised Signatory of the Importing Country

5. Item 6. Marks and 7. Number and kind of packages; description 8. Origin Conferring 9. Quantity (Gross weight 10. Invoice number(s)
number numbers on of goods including HS Code (6 digits) Criterion or other measurement), and date of
packages and brand name (if applicable) (see Notes Overleaf) and value (FOB) (see invoice(s)
Overleaf Notes)

1 BJBALL/49408/AU 24 PALLET RVC 95% 16,735.680 KGM 3010034773

CKLAND RETAIL LAMINATING, RAINBOW PAPER AND USD 25,975.22 NOVEMBER 10,
COLOUR PHOTOCOPY PAPER 2017

PEFC COC CERTIFICATE: CU PEFC-822059; 100%

PEFC CERTIFIED

G.W.: 16.735680 MT
N.W.: 15.566865 MT

HS: 4802.56 & 4802.58

KENSINGTON INTERNATIONAL LIMITED

HONG KONG

11. Declaration by exporter 12. Certification

The undersigned hereby declares that the above details and statements On the basis of control carried out, it is hereby certified that the information
are correct; that all the goods were produced in herein is correct and that the goods described comply with the origin
requirements specified in the Agreement Establishing the ASEAN-Australia-New
Zealand Free Trade Area
INDONESIA
..................................................................................................................
(Country) MUNICIPALITY OFFICE IN TANGERANG
and that they comply with the rules of origin, as provided in Chapter 3 of
the Agreement Establishing the ASEAN -Australia-New Zealand Free
Trade Area for the goods exported to

NEW ZEALAND
...................................................................................................................
(Importing Country)

PT. INDAH KIAT PULP & PAPER TBK. OKE SULENDRO SETYO RACHMAN
KOTA TANGERANG, NOVEMBER 22, 2017 TANGERANG, NOVEMBER 22, 2017
................................................................................................................. ................................................................................................................................
Place and date, name, signature and company of authorised signatory Place and date, signature and stamp of Authorised Issuing Authority/Body

13. Back-to-back Certificate of Origin v Subject of third-party invoice v Issued retroactively

De minimis Accumulation

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