LEMBAR LANJUTAN DOKUMEN PELENGKAP PABEAN

PEMBERITAHUAN EKSPOR BARANG (PEB)

100500
1. Kantor Pabean : KPPBC SAMARINDA
2. Nomor Pengajuan 00003095922920231114000135

No. Jenis Dokumen Nomor Dokumen Tanggal Kantor Pendaftaran

1 INVOICE CI-BENS/009/XI-2023 14-11-2023

2 PACKING LIST PL-BENS/009/XI-2023 14-11-2023
3 B/L BENSV2311/2023/1 14-11-2023
4 LETTER OF CREDIT (L/C) 025001373906 18-10-2023
5 EKSPORTIR TERDAFTAR (ET) DEPDAG 03.ET-04.21.0497 21-12-2021
6 LAP. PEMERIKSAAN SURVEYOR (LPS-E) LS.03.0944 14-11-2023

SAMARINDA, 15-11-2023
Eksportir/PPJK

EILEEN MELISA
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11127875346

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1. Products consigned from (Exporter's business name, address, country) Reference No. 1003461/SMD/2023

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PT BARA ENERGI NAGA SUKSES ASEAN-CHINA FREE TRADE AREA

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JL. PADAT KARYA NO. 001, KEL. SEMPAJA TIMUR, PREFERENTIAL TARIFF
KEC. SAMARINDA UTARA, KOTA SAMARINDA, CERTIFICATE OF ORIGIN

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PROVINSI KALIMANTAN TIMUR 75119 (Combined Declaration and Certificate)

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INDONESIA

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2. Goods consigned to (Consignee's name, address, country)

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FORM E

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SUMEC INTERNATIONAL TECHNOLOGY CO., LTD.
Issued in INDONESIA
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SUMEC BUILDING 198 CHANGJIANG ROAD,
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NANJING, CHINA 210018
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See Overleaf Notes
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3. Means of transport and route (as far as known) 4. For Official Use
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Departure Date NOVEMBER 14, 2023
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Preferential Treatment Given
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Vessel's name/Aircraft etc. MV. SHENG WEN
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Preferential Treatment Not Given (Please State reason/s)
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Port of Discharge LIANYUNGANG
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Signature of Authorised Signatory of the Importing Party
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5. Item 6. Marks and numbers 7. Number and type of packages, 8. Origin criteria 9. Gross weight 10. Number,
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number of packages description of products (including (see Overleaf Notes) or net weight or date of Invoices
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quantity where appropriate other quantity and
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and HS number in six digit code) value (FOB) only
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when RVC
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criterion is applied
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1 NO MARK IN BULK INDONESIAN STEAM COAL WO 48,641.000 TNE CI-BENS/009/XI/2023
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HS: 270112 (FORTY EIGHT NOVEMBER 14, 2023
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THOUSAND SIX
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CTPL PTE LTD HUNDRED FORTY ONE) INV/EXP/CN/040
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LEVEL 39, TOWER 2, MBFC BUILDING, NOVEMBER 23, 2023
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10 MARINA BOULEVARD, 018983
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SINGAPORE
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11. Declaration by the exporter 12. Certification

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The undersigned hereby declares that the above details and statement It is hereby certified, on the basis of control carried out, that the declaration by
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are correct; that all the products were produced in the exporter is correct.
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INDONESIA ISSUING OFFICE IN PROVINSI

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KALIMANTAN TIMUR
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(Country)
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and that they comply with the origin requirements specified for these
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Products in the Rules of Origin for the ACFTA for the products
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exported to
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CHINA
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(Importing Country)
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SAMARINDA, NOVEMBER 24, 2023

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Place and date, signature of authorized signatory

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13. Issued Retroactively Exhibition HERA NURAENI

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Movement Certificate Third Party Invoicing SAMARINDA, NOVEMBER 24, 2023

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Place and date, signature and stamp of certifying authority

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Page 1 / 1
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 PT. LEON TESTING AND CONSULTANCY
A Leon Overseas Group Company
Indonesia HQ
Citra Towers Office, North Tower, 20th Floor - 20E
JI. Benyamin Suaeb Kav. A6, Kemayoran, Jakarta 10630
Phone. +62-21-2260 5900

Certificate No: IDLSMSH2300496 Dated : October 19, 2023

Page 1 of 1

CERTIFICATE OF SAMPLING AND ANALYSIS

Name of TB/BG TB. CSA 6 / BG. CSA 3003
Quantity : 7,478.323 MT
Shipper PT. BARA ENERGI NAGA SUKSES
Description of Goods INDONESIA STEAMING (NON COKING) COAL IN BULK
Port of Loading JETTY RINJANI KARTANEGARA, EAST KALIMANTAN, INDONESIA
Port of Discharge MV. JIN HAI XIN AT MUARA JAWA ANCHORAGE,
EAST KALIMANTAN, INDONESIA
BL Date OCTOBER 15, 2023

THIS IS TO CERTIFY that we have performed the inspection, sampling and analysis of the coal consignment
nominated above. Samples were taken during loading at jetty and analyze as per ASTM standard methods. The
following results were obtained:

Specifications Basis Results

TOTAL MOISTURE (ARB) 14.27 PCT
INHERENT MOISTURE (ADB) 7.38 PCT
ASH (ADB) 7.78 PCT
VOLATILE MATTER (ADB) 40.97 PCT
FIXED CARBON (ADB) 43.87 PCT By difference
SULPHUR (ADB) 2.34 PCT
GROSS CALORIFIC VALUE (ARB) 5903 KCAL/KG
HGI 64
SIZE (0-50 MM) 90.00 PCT

Issued By
PT. Leon Testing and Consultancy
At Loading Port

UBLBLE JKT201023
Indonesia HQ
Phone: (+62)21 22605900 email : [email protected]
This certificate is issued on the Client's behalf, by the Company under its General Conditions of Service printed overleaf. The Client's attention is drawn to the
limitation of liability, indemnification and jurisdiction issues defined therein
 PT. LEON TESTING AND CONSULTANCY
A Leon Overseas Group Company
Indonesia HQ
Citra Towers Office, North Tower, 20th Floor - 20E
JI. Benyamin Suaeb Kav. A6, Kemayoran, Jakarta 10630
Phone. +62-21-2260 5900

Certificate No: IDLSMSH2300496 Dated: October 19, 2023

Page 1 of 1

DRAFT SURVEY REPORT

Name of TB/BG TB. CSA 6 / BG.CSA 3003

Quantity 7,478.323 MT
Shipper PT.BARA ENERGI NAGA SUKSES
Description of Goods INDONESIA STEAMING (NON COKING) COAL IN BULK
Port of Loading JETTY RINJANI KARTANEGARA, EAST KALIMANTAN, INDONESIA
Port of Discharge MV. JIN HAI XIN AT MUARA JAWA ANCHORAGE,
EAST KALIMANTAN, INDONESIA
BL Date OCTOBER 15, 2023
INITIAL FINAL
Date / Time October 13, 2023 16:40 LT October 15, 2023 01:50 LT
Draft Reading Port Stb. Mean Port Stb. Mean
Forward 0.730 0.690 0.710 m 4.330 4.320 4.325 m
Stern Correction 0.000 m 0.000 m
Corrected 0.710 m 4.325 m
Aft 0.790 0.710 0.750 m 4.740 4.680 4.710 m
Stern Correction 0.000 m 0.000 m
Corrected 0.750 m 4.710 m
Mean Forward & Aft 0.730 m 4.518 m
Midship
Midship Correction
Corrected
Mean of Means 0.7300 m 4.5175 m
Quarter Mean • "·, J 0.73000 m ( �-· I 4.51750 m
Corresponding Displacement 1,218.700 mt ,. 8,922.500 mt
Trim Correction 0.000 mt 0.000 mt
Displacement Corrected for Trim 1,218.700 mt 8,922.500 mt
Observed Density 0.995 0.995
Density Correction -35.669 mt -261.146 mt
Displacement Corrected for Density 1,183.031 mt 8,661.354 mt
Total Consumable Stores and Ballast 0.000 mt 0.000 mt
Net Displacement 1,183.031 mt 8,661.354 mt

TOTAL QUANTITY LOADED 7,478.323 MT

Issued By
PT. Leon Testing and Consultancy
At Loading Port

UBLBLE JKT201023
Indonesia HQ
Phone (+62)21 22605900 email: [email protected]

This certificate is issued on the Client's behalf, by the Company under its General Conditions of Service printed overleaf. The Client's attention is drawn to the
limitation of liability, indemnification and jurisdiction issues defined therein
 PT. LEON TESTING AND CONSULTANCY
A Leon Overseas Group Company
Indonesia HQ
Citra Towers Office, North Tower, 20th Floor - 20E
JI. Benyamin Suaeb Kav. A6, Kemayoran, Jakarta 10630
Phone. +62-21-2260 5900

Certificate No: IDLSMSH2300496 Dated : October 19, 2023

Page 1 of 1

CERTIFICATE OF WEIGHT
Name of TB/BG TB. CSA 6 / BG. CSA 3003
Quantity 7,478.323 MT
Shipper PT. BARA ENERGI NAGA SUKSES
Description of Goods INDONESIA STEAMING (NON COKING) COAL IN BULK
Port of Loading JETTY RINJANI KARTANEGARA, EAST KALIMANTAN, INDONESIA
Port of Discharge MV. JIN HAI XIN AT MUARA JAWA ANCHORAGE,
EAST KALIMANTAN, INDONESIA
BL Date OCTOBER 15, 2023

THIS IS TO CERTIFY that weight of the above mentioned cargo loaded at loading port was determined on the basis
of vessel's loading port draft survey result as follows

7,478.323 MT

The inspection was carried out to the best of our knowledge and this report reflects our finding as at time and place
for our inspection only.

Issued By
PT. Leon Testing and Consultancy
At Loading Port

UBLBLE JKT201023
Indonesia HQ
Phone: (+62)21 22605900 email : [email protected]
This certificate is issued on the Client's behalf, by the Company under its General Conditions of Service printed overleaf. The Client's attention is drawn to the
limitation of liability, indemnification and jurisdiction issues defined therein
 PT. LEON TESTING AND CONSULTANCY
A Leon Overseas Group Company
Indonesia HQ
Citra Towers Office, North Tower, 20th Floor - 20E
JI. Benyamin Suaeb Kav. A6, Kemayoran, Jakarta 10630
Phone. +62-21-2260 5900

Certificate No: IDLSMSH2300496 Dated : October 19, 2023

Page 1 of 1

CERTIFICATE OF ORIGIN
Name of TB/BG TB. CSA 6 / BG. CSA 3003
Quantity 7,478.323 MT
Shipper PT. BARA ENERGI NAGA SUKSES
Description of Goods INDONESIA STEAMING (NON COKING) COAL IN BULK
Port of Loading JETTY RINJANI KARTANEGARA, EAST KALIMANTAN, INDONESIA
Port of Discharge MV. JIN HAI XIN AT MUARA JAWA ANCHORAGE,
EAST KALIMANTAN, INDONESIA
BL Date OCTOBER 15, 2023

THIS IS TO CERTIFY THAT THE ABOVE-MENTIONED CARGO IS OF INDONESIAN ORIGIN.

Issued By
PT. Leon Testing and Consultancy
At Loading Port

UBLBLE JKT201023
Indonesia HQ
Phone: (+62)21 22605900 email : [email protected]
This certificate is issued on the Client's behalf, by the Company under its General Conditions of Service printed overleaf. The Client's attention is drawn to the
limitation of liability, indemnification and jurisdiction issues defined therein
 PT. LEON TESTING AND CONSULTANCY
A Leon Overseas Group Company
Indonesia HQ
Citra Towers Office, North Tower, 20th Floor - 20E
JI. Benyamin Suaeb Kav. A6, Kemayoran, Jakarta 10630
Phone. +62-21-2260 5900

Certificate No: IDLSMSH2300496 Dated : October 19, 2023

Page 1 of 1

CERTIFICATE OF HOLD CLEANLINESS

Name of TB/BG TB. CSA 6 / BG. CSA 3003
Quantity 7,478.323 MT
Shipper PT. BARA ENERGI NAGA SUKSES
Description of Goods INDONESIA STEAMING (NON COKING) COAL IN BULK
Port of Loading JETTY RINJANI KARTANEGARA, EAST KALIMANTAN, INDONESIA
Port of Discharge MV. JIN HAI XIN AT MUARA JAWA ANCHORAGE,
EAST KALIMANTAN, INDONESIA
BL Date OC TOBER 15, 2023

THIS IS TO CERTIFY, that at the request of the principals, we attended on board the above Barge at time and place
indicated above, for the hold cleaning inspection prior to the loading of barge,

Barge inspected as follows

TB. CSA 6 / BG. CSA 3003

In our opinion from a visual inspection, these hold were found suitably clean to receive a cargo of coal in bulk

It was noted that previous cargo was Coal and the bilges were dry and clean.

Issued By
PT. Leon Testing and Consultancy
At Loading Port

UBLBLE JKT201023
Indonesia HQ
Phone : (+62)21 22605900 email : [email protected]
This certificate is issued on the Client's behalf, by the Company under its General Conditions of Service printed overleaf. The Client's attention is drawn to the
limitation of liability, indemnification and jurisdiction issues defined therein