ORIGINAL

1. Exporter's name and address: Reference No.: -

PT. MINU GARMENT SUKSES
KP. BOJONG LARANG RT.09/04 DESA PONDOK KASO LANDEUH
KEC. PARUNGKUDA KAB. SUKABUMI 43157
INDONESIA INDONESIA-KOREA
COMPREHENSIVE
ECONOMIC PARTNERSHIP AGREEMENT
CERTIFICATE OF ORIGIN
2. Importer's name and address: (Combined Declaration and Certificate)
SHINSUNG TONGSANG CO., LTD
SHINSUNG BLDG 444 DUNCHON 2-DONG FORM IK-CEPA
GANGDONG-GU 134-822 SEOUL, KOREA

Issued in INDONESIA (Country)

(see Overleaf Notes)

3. Means of transport and route (as far as known): 4. Remarks:

Departure Date: NOVEMBER 23, 2023

Vessel/Flight/Train/Vehicle No.: INFERRO V.0003

Port of loading: TANJUNG PRIOK

Port of discharge: BUSAN, KOREA

5. Item 6. Description of goods (including
number number and type of package,
and quantity)
1 SAME AS INVOICE
618 CTNS = 30,333 PCS
96/4 POLY/SPAN 58/60"210 GSM
(WICKING) RECYLED POLY
MLX_DNSP23-219-01
MENS KNIT CRINKLE SOLID LS
T-SHIRTS
STYLE NO : MSE2TS1211A
7. HS code (Six digit code)
6109.90
8. Origin criterion 9. Gross weight or other 10. Number and date
measurements and FOB of invoice
Value (only when RVC /
QVC criterion is used)
"CC" 30,333.0000 PCE 001/TOPTEN/2023
(THIRTY THOUSAND THREE DECEMBER 22, 2023
HUNDRED THIRTY THREE)
USD 125,881.9500

11. Declaration by the exporter: 12. Certification:

The undersigned hereby declares that the above details and statement are It is hereby certified that the information herein is correct and that the goods
correct, that all the goods were produced in described comply with the origin requirements specified in the Indonesia -
Korea Comprehensive Economic Partnership Agreement.

INDONESIA
(Country) ISSUING OFFICE IN KOTA ADMINISTRASI
JAKARTA TIMUR
and that they comply with the origin requirements specified in the Indonesia -
Korea Comprehensive Economic Partnership Agreement for the goods
exported to

REPUBLIC OF KOREA
(Importing Country)

JAKARTA, -
SUKABUMI, - (Place and date, signature of authorized signatory)
(Place and date, signature of authorized signatory)