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PT LOGISTIK MANDIRI SAKTI
JL KISAMAUN GG. BALAI WARGA BABAKAN MASJID, NOMOR -, RT 003,
RW 007 GENERALIZED SYSTEM OF PREFERENCES
INDONESIA
CERTIFICATE OF ORIGIN
2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)
SHIPPED BY : BY AIR
TO : BARCELONA
5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
num numbers of criterion or other and date of
-ber packages (see notes quantity invoices
overleaf)
1 156 CARTONS P GW : 001/FI-EXP/I/2018
SAID TO CONTAIN : 1,386.39 KGS JANUARY 23,
156 CARTONS OF NW : 2018
-VW PRODUCTION MEN JACKET (J022824) 1,261.59 KGS
-VW PRODUCTION MEN TROUSERS (J022825)
-VW PRODUCTION WOMEN TROUSERS (J022826)
HS CODE : 6203.32.10
6203.42.10
6204.62.00
SPAIN
..................................................................................................
(importing country)
, TANGERANG,
..................................................................................................... ..................................................................................................
Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory
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