Orig 1, Products consigned from (Exporters business name, address, country) YINU YINBIN IMPORT & EXPORT CO, LTD 203, UNT. 5, 27 BUILDING, KIAMANG SECTION 3, JTANGDONG ‘STREET, YIU, ZHRJIANG CHINA 2, Products consigned to (Consignee’s name, address, country) CY. ASENY APPARE JL. CIKARAO NO, 33 RT. 003/R¥, 006. FANGISAGARA, WAIALAYA KAB, HANDING, “JANA BARAT ~ INDONESIA TELP 022-51091698 TAK 1D: 08, 050. 747, 9-444, 000 Reference No. 3290692408030458 ASEAN-CHINA FREE TRADE ARE: PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM E Issued in_THE PEOPLE'S REPUBLIC OF CHINA. ‘(Country See Overleat Notes ‘3. Means of transport and route (as far as known) Departure date JUL. 01, 2023 Vesser's name / Aircraftete. HYUNDAI GRACE V 0132" Port of Discharge CIKARANG DRY PORT, INDONESIA PROM SUANGHAZ, CILINA TO CIKARANG DRY PoRT, INDONESIA BY SHA 4. For Official Use Verifieation:origin. customs. gov. en 1 Preferential Treatment Given 1D Preferential Treatment Not Given (Please state reasons Signature of Authorised Signatory ofthe Importing Party S.ttem [6 Marks and ]7. Number and type of packages, description | 8. Origineriteria]9. Gross weight or nat | 10, Number, Number] numbers on | of proauets (including quantity where (see Overleaf | weightor oter quantity] date of packages | sppropriate and HS number in six digit code) | Notes) and valua (FOB) only | Invoices when RVC ertenon applied 1 ae IREE THOUSAND NINE ILNDRED (3900) “TE 23TLSRES 6. PACKAGES OF 92% POLYESTER STAPLE 8% aavo| STAPLE WOVEN FABRIC PLAIN WEAVE PIECE ben ILS. CODE: $612.19 2 [seven HUNDRED AND SIXTY FOUR (764) “me STBBKES 6. PACKAGES OF 57% VISCOSE FILAMENT lRavox STAPLE WOVEN FABRIC PIECE D\ Hi.S. CODE: 5408, 92 FOUR (4864) PACKAGES ONLY [FOTAL:FOUR THOUSAND SIX HUNDRED AND Sixty] 438 ED 11, Dectaration by the exporter ‘The undersigned hereby deciares that the above details ang statement are correct; that all the products wore produced in CHINA, nt) an that they comply with the origin requirements specified for thase products in the Rules of Origin forthe ACFTA for the products exported to INDONESTA (limporting Country) RareaRE cam é Place and ast Issued Retroactively 1D Movement Certificate 1D Third Party invoicing ART 06, 2023 sed signatory 13. 12, Certitieation in “then J 0 Place and date, signature and stamp of certfying authority 252921002647342OVERLEAF NOTES 1. Paris which accep this form for he purpose of preferential treatment under the ASEAN China Free BRUNEI DARUSSALAM ‘caMBODA CHINA INDONESIA tags: MALAYSIA MYANMAR PHILIPPINES SINGAPORE THAILAND VETNAM 2. CONDMONS: The main conitions for admission tothe preferential eatment under the ACFTA aretha products sent to any Parts listed above! (@) usta within a description of products eligible for concessions in the county of destination; (must comply vith al relevant provisions of Annex 1 (Rules of Origin) ofthe Protocl to Amend the Framework Agreement on Comprehensive Economie Co-operation and Cartan Agrees thereunder between the Association af Southeast Asian Nations (ASEAN) an the People’s RRepubte of Cha (ACFTA Upgrading Protocol 5. ORIGIN CRITERIA: For each good deserved in Box 7of ts form, the crgn criteria met should be indicated in Box inthe manner shown in the following table: Circumstances of production or manufacture nthe fst country named in Box this form | Insert in Box 8 (8) Goods wholy produced or obtained satisfying subparagraph (a) of Article 2 of Annex 1 of he ACFTA Upgrading Protocol be (©) Goods produced in a Paty exclusively fom aginating materials rom one er more of the Paris satin subparagraph (of Arce 2ofAmrex 1 ofthe ACFTA Upareding Proto | P= (©) Goods produced from non-riginating mata na Party. sattyng paragraph 1 of Article 4 of Annox 1 ofthe ACFTA Upgraing Protocol ‘Actual percentage of ACFTA valve Regional Value Content ‘content, example "40%" Change in Tarif Gassication atthe four-digit lovel TH (6) Goods satsying the Product Specific Rules (PSR) n Atachment 8 of Annex 1 ofthe ACFTA PSR Upgrading Protocol 4, EACH ARTICLE MUST QUALIFY It shouldbe noted that al the producs in @ consignment must quay separately in thelr own right. This cf partcularelavance when simiar aries of ciferent sizes or spare parts are sent 5. DESCRIPTION OF PRODUCTS: The description of products in Box 7 must be suicintydotaled o enabl the products to be identified by the Customs Officers examining thom, 6. The Harmonised System number ofthe imparting partyin Box (six dig code) shalbe determined according to the intematonal Convention on the Harmonized Commodity Deserpion and Coding System and subsequent amendments thereto. 1. The tem “Exporter n Box 1 and 1 may include the manufacturer or the producer. Inthe case of Movernent Cerca (MC), he term "Exporter also includes tho exporter in the intormediate Pary. For China, a Chinese manufacturer can apply fora Cetiiate of Origin (Form En the ‘ate where the manufacturer noeds o authorise other agencies to export ons behall. In his case, the manufacturer can make the decaraton indeated in Box 11 and shal stato the name and address ofthe exporter in Box 7. 8, FOROFFICIAL USE: The Customs Authority ofthe Importing Party must indicate (v) inthe relevant boxes in column 4 whether or not preferentaltreatmontis accorded. 9, MOVEMENT CERTIFICATE: in cases of Movement Certificate, accordance with Rule 12 of Atachment A of te Rule of Org ofthe ACETA Upgrading Protocol (Operational Cetieation Procedures} () "Movement Cetfcae” in Box 13 shouldbe ticked () (I) the indicated value in {Box 9 shall be the ivoioe value ofthe products exported fram the intermediate Pay. The indicated value in Box 9s only required when the RVC citerion i applied, (5) The name ofthe orginal Issuing Authories of the Party, date of the issuance and the reference numberof the ‘tignal Cerificate of Origin (Form E) tobe inccated in Box 7 10. THIRD PARTY INVOICING: In cases where invoices are issued by a third country, the Third Party Invoicing” in Box 13 shal be tckod (\). “The invoice number shal be indicated in Box 1. Information such as name and country ofthe company ising the invoice shal be indicated inBox 7 |. EXHIBITIONS: In cases where procucts are sant fram the exporting Party for exhbiton in another Party_and sold uring or after the exhibition for imporaton into a Party, in accordance wth Rue 22 of Atachment A ofthe Rules of Origin forthe ACFTA, the “Exhbsons in Box 13 shoud ‘be ticked () andthe name and address ofthe exibonindcated in Box 2 12 ISSUED RETROACTIVELY: In exceptional cass, du to inveluntary eros or omissions or other valid causes, the Crit of Orig (Form E) ‘may be Issued retroactively in accordance with Rul 1 of Attachment A of the Rules of Origin for the ACFTA. The “Issued Retoactwoly” ln Box 13 shal be ticked (\) elecronelly or ypewriten tagather wih oer information Inthe Cerca of Origin (Form). In casas whera te "Issued Revoactvely” inBox 13 cannot be ticked elocronically 0” typewritten, the Certficate of Orgin (Form E) shall be stamped wit the words ISSUED RETROACTIVELY”