Triplicate

1.Products consigned from(Exporter’s business name,address, Reference No. E205670467041005

country)
NINGBO SUNWELL SEALING MATERIALS CO.,LTD.
ADD：ROOM 106,BUILDING 2,NO.8 XINGYE ROAD,FREE TRADE
ZONE,NINGBO,ZHEJIANG,CHINA ASEAN-CHINA FREE TRADE AREA
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
PT.VASTEX INTI MULIA
ADD:JL.DARU III NO.32 KAWASAN INDUSTRI-DELTA SILICON FORM E
5 LIPPO CIKARANG 17530 JAWA BARAT - INDONESIA. 非有效证书
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Verification:origin.customs.gov.cn
Departure date DEC. 31,2020 □ Preferential Treatment Given

Vessel's name/Aircraft etc. ****

Port of Discharge JAKARTA, INDONESIA

□ Preferential Treatment Not Given(Please state reason/s)

FROM SHANGHAI,CHINA TO JAKARTA,INDONESIA

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Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on of products (including quantity where (see Overleaf weight or other quantity, date of
packages appropriate and HS number in six digit code) Notes) and value (FOB) only lnvoices
when RVC criterion is
applied
ONE （1）CASE OF STAINLESS STRIP SW20TT1134
HOOP TYPE: FLAT ; DEC. 26,2020
THICKNESS:0.18-0.20MM;WIDTH: 5.0MM

1 HOOP SUPER DUPLEX S32750 "PE" 35.4KGS N.W.

HS CODE: 7222.20

2 HOOP INCOLOY 825 "PE" 10.6KGS N.W.

HS CODE: 7222.20
*** *** *** *** ***

SW20TT1134
243/VIM/PO/XII/2020
NO.

11.Declaration by the exporter 12.Certification

The undersigned hereby declares that the above details
it is hereby certified on the basis of control carried out,that the
and Statement are correct,that all the products were produced in
declaration by the exporter is correct
CHINA
-------------------------------------------------
(Country)
and that they comply with the origin requirements specified for
these products in the Rules of Origin for the ACFTA for the
products exported to

INDONESIA
---------------------------------------------
(Importing Country)

Ningbo, China,DEC. 26,2020

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Place and date，signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority