PART A: FOR USE BY AUTHORITIES OF ISSUING COUNTRY ICO CERTIFICATE OF ORIGIN

1. Exporter/consignor (name/code)
PT SULOTCO JAYA ABADI
DESA BOLOKAN, TIROAN, BITTUANG,
TANA TORAJA SULAWESI SELATAN INDONESIA Certificate of Origin
BY THE ORDER OF G. BIJDENDIJK BV

2. Internal Reference No 3a. Country Code 3b. Port of shipment 3c. Serial No
Code

0 1 5 1 7 1 0 0 8 9

4. Producing Country (name/code)

INDONESIA
0 1 5
5. Country of destination (name/code) 6. Date of export (DD/MM/YY)
ARMENIA
07/12/22
2 6 6
7. Means of transport

Sea x Air Land Rail River Multimodal

8. ICO Identification mark or Unique Consignment Reference or other 9. Shippend in

identification
015/_ _ _ _ /043
____ Bags x Bulk Containers x Other

Other marks "SEE ATTACHMENT" 10. Net weight of shipment 11. Unit of weight

19,200.0000 x Kg Ib

12. Description of coffee (form/type, where relevant)

Green Arabica Green Robusta x Roasted Soluble Liquid Other

13. Method of processing

Decaffeinated Organic: Certified Uncertified

Green Coffee: Dry x Wet Soluble coffee: Spray-dried Freeze-dried

14. IT IS HEREBY CERTIFIED THAT THE COFFEE DESCRIBED ABOVE WAS PRODUCED/PROCESSED IN THE COUNTRY NAMED IN BOX 4 ABOVE AND HAS
BEEN EXPORTED ON THE DATE SHOWN BELOW. THIS CERTIFICATE IS INTENDED SOLELY FOR THE STATISTICAL PURPOSES OF THE ICO AND DOES
NOT CONFER ORIGIN ON COFFEE.

ISSUING OFFICE IN PROVINSI LAMPUNG

Date DECEMBER 13, 2022

Place BANDAR LAMPUNG
Signature of authorized Customs Officer or Certifying Officer and Cachet of Customs Authority or Certifying Agency

15. Other relevant information: ICC Resolution 420; Special characteristics; HS Code; Value of the shipment (Voluntary information)

a. Quality standards for green coffee (ICC Resolution 420):

“S": Full compliance with the target defect and moisture standards x "XD": Coffee does not conform to the target defect standard

“XM": Coffee does not conform to the target moisture standard "XDM": Coffee does not conform to either standard
(target defect and moisture)

b. Special characteristics (please specify name or code): INDONESIA ROBUSTA COFFEE ELB GR. 2 400 BC

c. Harmonized System (HS) code d. Value (FOB) of the shipment: 27,840.0000

HS Code: 09011130 National Currency x US dollars Euros

e. Additional Information
CONSIGNEE:
GRAND CANDY LLC 33 HRANT VARDANYAN STR, YEREVAN,
ARMENIA ZIP/POSTAL CODE: 0061
E-MAIL: COMMERCE@GRANDCANDY.AM
TEL: +374 10 44 56 33

Page 1 / 1