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CY. UJANG JAY A
EXPORT - IMPORT
Office: JI. Tangguk Bongkar IX No.90B Medan - Indonesia
Telp: (62-61) 8453929 Fax: (62-61) 8454070
Warehouse: JI. Garuda 2 No.95 Km.l3.8 Sei Semayang - Binjai - Medan
Email: u74ng@indosat.net.id
INVOICE
CV. UJANGJAYA FLO-ID6117
SCHEDVLEOF Always quote ref
REMITTANCE number
I I AlUJ/CIIXII120I I
FDA NUMBER 11271807930
Postal Address : JI. Tangguk Bongkar IX No. 90B Bankers: Gulf International Bank (UK) Ltd.,
Medan Indonesia One Knigbtsbridge, ,London SWIX7XS
Phone : Mobile Phone 628126472039 SWIFf CODE: SINTGB1LXXX
E-mail : u7-lng:iiindosat.net.id Correspondent Bank: HSBC Basnk USA, 140
Dated : April 03,2011 Broadway, New York NY 10005 U.s.A.
Swif Code: MRMDUS33
Tol Buyer : Cooperative Coffees, Inc FLO-ID 1341 Tennor:
302 W. Lamar St. Suite E.
Cuh Againts Document ( CAD)
Americus, GA 31709 USA
Beneficiary: IDB-ITFC-OPERA T10NS
Tel. +1-229-924-3035
Fax. +1-229-924-6250
AlC NO. AlC NO.
GB13SINT60918000159151 (USD)
Convering Shipment of: 300 BAGS DESTINATION:
100010 Organic Arabica Coffee APKO FLO-ID18214
Commercial Invoice No. IIA I VI I CI I XII 12011 NEW YORK, NY
Vessel Name: Jaru Bhum V. 231 E BIL No. MESLAXI LOO3 CONTRACT NO.
Dated. Dec 18, 20 II SUG113
Container & Seal No: HJCU8277313 I S I HB935435
Doc Comm Packing Bill Of ICO FormA Clean Qualiy Weight Phyto Amount Claimend :
Invoce List Lading Cert Cert Cert Cert Cert Cert
Usd.147,6OO
I St 4 4 6 4 4 4 4 4 4
Mail
2nd
Mail - - - - - - - - -
DISPOSTAL INSTRUCTION
We CertifY That the Goods has been Shipped as per your instruction
And the documents full complied with the tenns and conditions.
PIs remit the proceeds to our Account No. AlC. GB23SINT609280001S9151 (USD)
INTERNATIONAL ISLAMIC TRADE FINANCE CORPORATION (ITFC)
BANKERS: GulfIntemationai Bank (UK) Ltd., One Knightsbridge, London SWIX7XS.
Correspondent Bank: OSBC Bunk USA, 140 Broadway, New York NY 10005 U.S.A.
PIs Fax us receipt of payment transfer
Medan, Dec 17, 2011
" ", ' _ ""-:0
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...
IRADJiUr:HAS-N-AN--
Direktur

BILL OF LADING
UNIVERSAL SHIPPING. INC.
CTPAT NO. 72545308 OTI LICENSE NO. 17577NF
SHIPPER/EXPORTER: DOCUMENT NO.
IBILL OF LADING NO
MESLAX1L003
CVUJANGJAYA
DOMESTIC ROUTING/EXPORT INSTRUCTION
JL.TANGGUK BONGKAR IX NO.9OB MEDAN INDONFSIA
TEL; 6261-8453929 FAX; 6261-8454070
FDA REGISTRATION NO.l127180?930 SCAC CODE: UNSL
CONSIGNEE EXPORT REFERENCES:
COOPERATIVE COFFEFS, INC
MBL NO : HJSCBLWl03553200
302 W.LAMAR sr, SUITE E.
FOR CARGO DELIVERY PLEASE CONTACT
AMERICUS, GA 31709 USA
PHONE: +1-229-924-3035 FAX: +1-229-924-6250 UNIVERSAL SIDPPlNG, INC.
ATTN: BILL HARRIS 2855 SOUlH RESERVOIR STREET,
POMONA, CA 91766
>';OTIFY PARTY
EXCELCO TRADING LP.
TEL: (909) FAX : (909)
17 BATTERY PLACE, SUITE 1010
NEW YORK, NY 10004
PHONE: +1-212-344-6771 FAX :+1-212-344-8723 FORWARDING AGENT - REFERENCES
AnN: GOERGE TSIAS1SlO5
'PRECARRIAGE BY 'PLACE OF RECEIPT
JARU BHUM V.231E BELAWAN, INDONESIA CY
EXPORTING CARRIER PORT OF LOADING: ON CARRIAGE BY:
NO. OF BILLS OF LADING
AI<INADA BRIDGE VJXJ57W BELAWAN, INDONFSIA CY
PORT OF DISCHARGE PLACE OF DELIVERY FINAL DESTINATION:
NEW YORK. NY NEW YORK. NY
PARTICULARS FURNISHED BY SHIPPER
MARKS AND NUMBERS NO. OF PKGS. DESCRIPTION OF PACKAGES AND GOODS
GROSS WEIGHT MEASUREMENT
CONTAINER/ SEAL SHIPPER'SWAD, STOW WEIGHI' AND COUNT
HJCU8277313/1IB!m435 1 X 2O'SfD CONTAINER : : 18,300.00 KGS
MAlUClNG: 300 BAGS : 18,000.00 KGS
tn5/1fm/llA 100% ORGANIC ARABlCA COFFEE APKO
CV.UJANG JAYA FLO-ID FLO-ID 18214
CERtifiED100%ORGANI
ARABICA COFFEE APKO Dl82l4
FLO-FAlRTRADE <...*y/c..:y
SUMATRAN SEMI WAS
CONTRACf. SUG123
COOPERATIVE COFFEES C FLO-IDl3f1
PRODUCf OF INDONESIA
2011 HARVEST
US HOPAND IFOAM CD
CERt IFIEDORGANIC
NEITfiOKG
TOTAL NUMBER OF CONTAINERS OR
1X20' CONTAINER ONLY
PACKAGED (IN WORLD)
RECEIVED by the Carrier the Goods as specified above in apparent good order and condition
FREIGHT CHARGES PREPAID COLLECT
unless otherwise stated, to be transported to such place as agreed, authorized or permitted hereon
and subject to all the terms and conditions appearing on the front and reverse of this Bill of Lading
to which the merchant agrees by accepting this Bill of Lading, any local privileges and customs
notwithstanding.
The particulars, given above as stated by the shipper and the weight, measure, quantity condition,
FREIGHf COLLECT
contents and value of the Goods are unknown to the Carrier.
In WITNESS whereof one (1) original Bill of Lading has been signed if not otherwise stated above
the same being accomplished the other if any to be void if required by the Carrier one (1) Original
Bill of Lading must be surrendered duly endorsed in exchange for the goods of delivery order.
BELAWAN, DECEMBER 18,2011
Place and date of issue
signed on behalf of the Carrier:
EXCESS VALUE CHARGE
By
TOTAL CHARGES
CERTIFICATE F'.)R !MPORT INTO NON EUROPEAN COMMUNITY COUNTRIES OF
PRODUCTS OBTAINED ACCORDING TO ORGANIC PRODUCTION METHODS
1. Body Issuing the Certificate (Certifying Body)
(Name & Address)
NASAA CERTIFIED ORGANIC PTY LTD
UNIT 7,3 MT BARKER RD
STIRLING SOUTH AUSTRALIA 5152
3. Exporter of the product (Name & Address)
CV. UJANG JAVA
JL. TANGGUK BONGKAR IX 90B MEDAN 20226
INDONESIA
5. Producer or Processor of the product (Name & Address)
CV. UJANG JAVA
JL. GARUDA 2 NO. 95 KM. 13,8 SEI SEMAVANG
BINJAI MEDAN 20351 INDONESIA
7. First consignee of the product (Name & Address)
Cooperative Coffees Inc.
302 W. Lamar St. Suite E.
Americus, GA 31709 USA
Tel. +1-229-924-3035
Fax. +1-229924-6250
10. Marks & Numbers, Container No(s),Number & Kind Trade Name of the Product
015/1607l11A CV. UJANG JAVA FLO-ID 6117 CERTIFIED 100% ORGANIC
ARABICA COFFEE APKO FLO-ID 18214 "FLO-FAIRTRADE" SUMATRAN SEMI
WASHED BEANS CONTRACT# SUG123 COOPERATIVE COFFEES INC FLO-ID 1341
PRODUCT OF INDONESIA 2011 HARVEST US NOP AND IFOAM CERTFIED
CERTIFIED ORGANIC NETT 60 KGS 1/300
HJCU2205487 I S I HB938839
100%Organic Arabica Coffee APKO FLQ-ID 18214
14. Declaration of the organisation issuing the certificate.
2. Reference Number
Article Reference Number of the Certificate
NCO 495
4. Control Body (Name & Address)
NASAA CERTIFIED ORGANIC PTY LTD
UNIT 7, 3 MT BARKER RD
STIRLING SA 5152
AUSTRALIA
(IFOAM accredited)
6. Country of Despatch
INDONESIA
68. Port of discharge
BELAWAN, INDONESIA
8. Country of Destination
USA
9. Address of the place of
Destination
NEWYORK,NY
Cooperative Coffees Inc.
302 W. Lamar St. Suite E.
Americus, GA 31709 USA
Tel. +1-229-924-3035
Fax. +1-229-924-6250
11. Gross Weight (kg)
18,300
12. Nett Weight (kg)
18,000
13. Alternative Units
300 BAGS
This is to certify that the products designated above have been obtained in accordance with the rules of production and
on inspection of the organic production method, as set out and monitored by the control organisation mentioned in Box 4
15. Additional declaration (if appropriate)
15a.lnclude products from growers
(Registration numbers)
15b. Date of Departure
15c. Vessel/Flight Details
16. Place of Issue of the certificate
jq
Dec
201/
Date:
LRe.
tl
Name and signature of NASAA authorised pel'Son
Explanatory Notes:
8133P
Dec 19,2011
Jaru Bhum V.231E
Stamp of the issuing organisation
NASAA CERTIFIED ORGANIC
POBOX 768
STIRLING SA 5'52
PH: (08) 83708455
FAX: (08) 8370 8381
NOPACCREOITED
Box 4: Control body for monitoring compliance with the rules on organic production methods
Box 5: The firm which carried out the last operation (processing, packaging, labelling) on the batch
Box 9: The address of the firm where the batch wll be delivered, ifdifferent from the address in box 7
Box 13: e.g. volume in litres in case ofliquids, to be given, where appropriate, in supplement to the declarations in boxes II and 12