Original "Goods consigned from (Exporters business name, address, country) COUNTEC co.LTD. ‘TBSANEOP-RO, BUCHEON-Sl, GYEONGGI-DO, 14402 KOREA, “ot 0325749323 Fax: 0526749322 Reference No. C023-24-0005121 Reference code. v2av-313r KOREA-ASEAN FREE TRADE AREA PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN 2Goods consigned to (Consignee’ name, adress, country) FPTSURYAPRANA NUTRISINDO ‘L LAUTZE RAVA NO. 1-3 RT 003, RW. O01 KEL KARANG "ANYAR, KE. SAWAH BESAR JAKARTA PUSAT 1074D INDONESIA NPWP:O1 00 188 3075 000 TEL: 62216259767 FAX: 6221-€258785 PIC: MR. HENDRA (Combined Declaration and Certificate) FORM AK Issued in the REPUBLIC OF KOREA (Country) See Notes Overieat ‘3Means of transport and routelas fer as known) Departure date: 28 DEC, 2024 Vessels name/Aircraft etc: YEOSU VOYAGER 2410S Port of Discherge :Jekarta, Indonesia 4 For official use 2. Preferentl Teetment Given Under KOREA-ASEAN Free Trade Aves Preferential Tai Treatment Not Given Please state reasor/s) tory 0 \aunnnninninnnn \1 UN HS No. 642230 [Shen [Marks and Number and ype of packages destoion of goods [acrgin rumba} numbers on (rung cuantiy where approprite and HS number criterion packages ofthe importing county) (cee notes ‘oveleaf) 7 FISRVAPRAN an om “730 CT Ze 0067 unin \nstasinoo |SACHET DESICCANT INSERTER 6-200 ununonn | namnienay or06 loa: 13-308 SELF ADHESIVE LABELER 2008PMY HIGH SPEED L9-200 lo Dec, 2028 [MADE IN KOREA |SACHET DESICCANT INSERTER 6-120 anno \nnncnarnnnnnnnnn 111 -Declaration by the exporter ‘The undersigned hereby declares that the above eta and statements are correct, that all the goods were produced in THE REPUBLIC OF KOREA (Country) ‘and that they comply with the origin requirements specified for these goods in the KOREA-ASEAN Free ‘rade Area Preferential Tariff for goods exported to INDONESMeoyperc coin {importing Cougesy) ae G, lace and date, signature of authorized signatory 12.Certification Itis hereby certified on the basis of control carried out, that the declaration by the exporter is correct, Kim Ki Hong 13. _[) Third Country Invoicing CO Exhibition (1 Back-to-Back C/O 1 You can veify the authenticity ofthis Certificate of Origin at wowwcustomago.k/co.tm!et Triplicate Bee fe: Ser uee 1 Goods consigned fom (Spores buses name Reference No. €023-24-0005121 ress, corny) Reference code. v2av-313r COUNTEC Co.17D. TaSANEO?-RO, BUCHEON-SI, GYEONGK Tet 0326749323 Fax 0326749322 I-00, 14402 KOREA 2.Goods consigned to (Consignees name, address, country) PTSURYAPRANA NUTRISINDO JL LAUTZE RAYA NO. 1-3 RT. 003, RW. 001 KEL KARANG |ANVAR, KEC. SAWAH BESAR JAKARTA PUSAT 10740 INDONESIA [NPWE: 01 600 188 3 075 000 TEL : 62216259787 FAX: 8221-€259785 PIC: MR. HENDRA KOREA-ASEAN FREE TRADE AREA PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM AK Issued in the REPUBLIC OF KOREA (Country) See Notes Overleat Means of transport and route(as far as knowa) Departure date : 28 DEC, 2024 Vessels name/Aicraft etc: YEOSU VOYAGER 24105 Port of Discharge : Jakarta, Indonesia 4, For official use D Preferential Treatment Given Under KOREA-ASEAN Free Trade Avea Preferential Taf DPreerentil Trestment Not Given (Pease tate reasons) \amniniirnninnny \V UN HS No, 642230 Sen [EMarks and [7A and pe of patages desaion of goods Borgia anus rumbe} numbers on Gnduting quanty wher appropriate and HS number criterion nd date of packages ‘ofthe impoting county) see notes ineices ‘overlaf) 1 | FTSURVAPRANA Bio oH “1 THRG) [CTH BE 0062 ann \wotsinoo |SACHET DESICCANT INSERTER 6-200 annua | seuanennor06 lcmo: 13 - 373 SELF ADHESIVE LABELER 20080MY HIGH SPEED L8-200 [0 Dec, 2024 MADE IN KOAEA 'SACHET DESICCANT INSERTER 6-120 ‘aunts union 11.Declaration by the exporter ‘The undersigned hereby declares that the above details and statements are correct, that all the goods ‘were produced in THE REPUBLIC OF KOREA (Country) and that they comply with the origin requirements specified for these goods in the KOREA-ASEAN Free ‘Trade Area Preferential Tariff for goods exported to INDONESIA o ners co..20. ~Timporting COUN Ln Low ET PRSRT lace end date, signature of authorized signatory 12.Certification Itis hereby certified on the basis of control carried out, that the declaration by the exporter is correct kim Ki Hong 13.) Third Country Invoicing CO Exhibition Co Back-to-Back C/O 1 You can verify the authenticity ofthis Cerca of Origin & wwncustomsgola/colimi v7