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1. Goods consigned from (Exporter’s business name, address, country) IDEAL BEAUTY ALLIANCE SDN BHD NO.39, JALAN PUTERI 5/18 BANDAR PUTERI 47100 PUCHONG, SELANGOR, MALAYSIA . Goods consigned to (Consignee’s name, address, country) PT. PANGESTU JAYA ABADI RUKO TAMAN PALEM LESTARI BLOK D1 NO. 9, CENGKARENG JAKARTA BARAT 11730 JAKARTA INDONESIA . Means of transport and route (as far as known) Departure date 09 September 2023 by MARITIME TRANSPORT Vessel’s name/Aircraft etc. WAN HAI 509/ VY. S129 Port of Discharge JAKARTA, JAVA 6. Marks and numbers on packages 7. Number and type of packages, descri (including quantity where appropriate of the Importing Country) 87 CARTON WHITE GARDEN PURE GOAT'S MILK & PEARL SHOWER CREAM 1100ML [12PCS/CTN] 1044 PIECE PREVIEW Reference No, KL-202309-CCF-1005653-K-086859 ASEAN TRADE IN GOODS AGREEMENT CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM D MALAYSIA Issued in (Country) See Overleaf Notes 4. For official use Preferential Treatment Given Under ASEAN Trade in Goods Agreement Preferential Treatment Not Given {Please state reason/s) || | Signature of Authorised Signatory of the Customs Authority of the Importing Country 8. Origin criterion (see Overleaf Notes) ption of goods and HS number 9. Gross weight or other quantity and FOB price where RVC is applied 10. Number and date of invoices 1044 PIECE IVWG2308/001 30/08/2023 IMPORTING COUNTRY HS CODE 34012099 94 CARTON WHITE GARDEN JEJU MANDARIN SHOWER CREAM 1100ML [12PCS/CTN] 1128 PIECE 1128 PIECE IVWG2308/001 30/08/2023 IMPORTING COUNTRY HS CODE 34012099 337 CARTON WHITE GARDEN PURE GOAT'S MILK & PEARL Pa; 11. Declaration by the exporter The undersigned hereby declares that the above details and statement are correct; that all the goods were produced in MALAYSIA (Country) and that they comply with the origin requirements specified for these goods in the ASEAN Trade in Goods Agreement for the goods exported to INDONESIA (Importing Country) SELANGOR , 13 September 2023 Piace and date, signature of authorised signatory 13. C Third-Country Invoicing OC Exhibition LC) Accumulation CJ De Minimis L] Back-to-Back CO . V] Issued Retroactively O Partial Curnulation . Goods consigned from (Exporter’s business name, address, country) IDEAL BEAUTY ALLIANCE SDN BHD NO.39, JALAN PUTERI 5/18 BANDAR PUTERI 47100 PUCHONG, SELANGOR, MALAYSIA . Goods consigned to (Consignee’s name, address, country) PT. PANGESTU JAYA ABADI RUKO TAMAN PALEM LESTARI BLOK D1 NO. 9, CENGKARENG JAKARTA BARAT 11730 JAKARTA INDONESIA . Means of transport and route (as far as known) Departure date 09 September 2023 by MARITIME TRANSPORT Vessel’s name/Aircraft etc. WAN HAI 509 / VY. $129 Port of Discharge JAKARTA, JAVA 6. Marks and numbers on packages . Item number of the Importing Country) SHOWER CREAM 900ML [12PCS/CTN] 4044 PIECE 7. Number and type of packages, description of goods (including quantity where appropriate and HS number IVWG2308/001 30/08/2023 ge 1 of 4 } 12. Certification ” ttis hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. for Secretary General Ministry of Investment, Trade and Industry Malaysia Kuala Lumpur , 13 September 2023 [CPT-CCF-W-230913-KL-000034] Place and date, signature and stamp of certifying authority PREVIEW Reference No, KL-202309-CCF-1005653-K-086859 ASEAN TRADE IN GOODS AGREEMENT CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM D MALAYSIA Issued in (Country) See Overleaf Notes 4. For official use || || Preferential Treatment Given Under ASEAN Trade in Goods Agreement Preferential Treatment Not Given (Please state reason/s) Signature of Authorised Signatory of the Customs Authority of the Importing Country 8. Origin criterion (see Overleaf Notes) 9. Gross weight or other quantity and FOB price where RVC is applied 10. Number and date of invoices IMPORTING COUNTRY HS CODE 34012099 139 X 12 139 CARTON WHITE GARDEN PINK ROSE SHOWER [12PCS/CTN] 1668 PIECE IMPORTING COUNTRY HS CODE 34012: 378 CARTON WHITE GARDEN JEJU MANDARIN SHOWER CREAM 900ML [12PCS/CTN] 4536 PIECE 1668 PIECE IVWG2308/001 CREAM 900ML 30/08/2023 099 IVWG2308/001 30/08/2023 Page 2 of 4 11. Declaration by the exporter The undersigned hereby declares that the above details and statement are correct; that all the goods were produced in MALAYSIA (Country) and that they comply with the origin requirements specified for these goods in the ASEAN Trade in Goods Agreement for the goods exported to INDONESIA (Importing Country) SELANGOR , 13 September 2023 Piace and date, signature of authorised signatory 13. CL Third-Country Invoicing C Exhibition (J Accumulation CJ De Minimis L] Back-to-Back CO . V] Issued Retroactively O Partial Curnulation . Goods consigned from (Exporter’s business name, address, country) IDEAL BEAUTY ALLIANCE SDN BHD NO.39, JALAN PUTERI 5/18 BANDAR PUTERI 47100 PUCHONG, SELANGOR, MALAYSIA . Goods consigned to (Consignee’s name, address, country) PT. PANGESTU JAYA ABADI RUKO TAMAN PALEM LESTARI BLOK D1 NO. 9, CENGKARENG JAKARTA BARAT 11730 JAKARTA INDONESIA . Means of transport and route (as far as known) Departure date 09 September 2023 by MARITIME TRANSPORT Vessel’s name/Aircraft etc. WAN HAI 509/ VY. S129 Port of Discharge JAKARTA, JAVA 6. Marks and numbers on packages . Item number of the Importing Country) IMPORTING COUNTRY HS CODE 34012: 81 CARTON WHITE GARDEN PURE GOAT'S MILK & PEARL SHOWER CREAM 450ML [24PCS/CTN] 1944 PIECE IMPORTING COUNTRY HS CODE 34012: 1 CARTON WHITE GARDEN JEJU MANDARIN SHO 500ML [12PCS/CTN] 12 PIECE IMPORTING COUNTRY HS CODE 34012 7. Number and type of packages, description of goods (including quantity where appropriate and HS number } 12. Certification ” ttis hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. for Secretary General Ministry of Investment, Trade and Industry Malaysia Kuala Lumpur , 13 September 2023 [CPT-CCF-W-230913-KL-000034] Place and date, signature and stamp of certifying authority PREVIEW Reference No, KL-202309-CCF-1005653-K-086859 ASEAN TRADE IN GOODS AGREEMENT CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM D MALAYSIA Issued in (Country) See Overleaf Notes 4. For official use || | Preferential Treatment Given Under ASEAN Trade in Goods Agreement Preferential Treatment Not Given {Please state reason/s) Signature of Authorised Signatory of the Customs Authority of the Importing Country 8. Origin criterion (see Overleaf Notes) 9. Gross weight or other quantity and FOB price where RVC is applied 10. Number and date of invoices 099 1944 PIECE IVWG2308/001 30/08/2023 099 IVWG2308/001 WER CREAM 30/08/2023 099 Page 3 of 4 11. Declaration by the exporter The undersigned hereby declares that the above details and statement are correct; that all the goods were produced in MALAYSIA (Country) and that they comply with the origin requirements specified for these goods in the ASEAN Trade in Goods Agreement for the goods exported to INDONESIA (Importing Country) SELANGOR , 13 September 2023 Piace and date, signature of authorised signatory 13. O Third-Country Invoicing CJ Exhibition C1 Accumulation C1 De Minimis LJ Back-to-Back CO . V] Issued Retroactively O Partial Curnulation . Goods consigned from (Exporter’s business name, address, country} IDEAL BEAUTY ALLIANCE SDN BHD NO.39, JALAN PUTERI 5/18 BANDAR PUTERI 47100 PUCHONG, SELANGOR, MALAYSIA . Goods consigned to (Consignee’s name, address, country) PT. PANGESTU JAYA ABADI RUKO TAMAN PALEM LESTARI BLOK D1 NO. 9, CENGKARENG JAKARTA BARAT 11730 JAKARTA INDONESIA . Means of transport and route (as far as known) Departure date 09 September 2023 by MARITIME TRANSPORT Vessel’s name/Aircraft etc. WAN HAI 509/ VY. S129 Port of Discharge JAKARTA, JAVA 6. Marks and numbers on packages of the Importing Country) 4X 12 PCS 4 CARTON WHITE GARDEN LAVENDER CHAMOMILE SHOWER CREAM 500ML [12PCS/CTN] 48 PIECE 7. Number and type of packages, description of goods (including quantity where appropriate and HS number } 12. Certification ” ttis hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. for Secretary General Ministry of Investment, Trade and Industry Malaysia Kuala Lumpur , 13 September 2023 [CPT-CCF-W-230913-KL-000034] Place and date, signature and stamp of certifying authority PREVIEW Reference No, KL-202309-CCF-1005653-K-086859 ASEAN TRADE IN GOODS AGREEMENT CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM D MALAYSIA Issued in (Country) See Overleaf Notes 4. For official use || || Preferential Treatment Given Under ASEAN Trade in Goods Agreement Preferential Treatment Not Given {Please state reason/s) Signature of Authorised Signatory of the Customs Authority of the Importing Country 8. Origin criterion (see Overleaf Notes) 9. Gross weight or other quantity and FOB price where RVC is applied 10. Number and date of invoices IVWG2308/001 30/08/2023 IMPORTING COUNTRY HS CODE 34012099 Page 4 of 4 11. Declaration by the exporter The undersigned hereby declares that the above details and statement are correct; that all the goods were produced in MALAYSIA (Country) and that they comply with the origin requirements specified for these goods in the ASEAN Trade in Goods Agreement for the goods exported to INDONESIA (Importing Country) SELANGOR , 13 September 2023 Place and date, signature of authorised signatory 13. CJ Third-Country Invoicing CJ Exhibition CL Accumulation LC De Minimis L] Back-to-Back CO . V] Issued Retroactively O Partial Curnulation 14424 PIECE OTHER } 12. Certification " {tis hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. for Secretary General Ministry of Investment, Trade and Industry Malaysia Kuala Lumpur , 13 September 2023 [CPT-CCF-W-230913-KL-000034] Place and date, signature and stamp of certifying authority
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