PT POS INDONESIA (Persero) CUSTOMS DECLARATION CN 23

From Name : SRI UTAMI Sender customs

reference No. of item (barcode, if any) MAYBE OPENED OFFICIALY
+628596889453
NIK-3314110706710001
Address : PERUMAHAN GRIYA SIDOHARJO
ASRI GANG 3 KIRI RT 21 SINGOPADU
SIDOHARJO SRAGEN
Declaration
Address : ID
C D S 0 2 2 4 2 3 6 4 7 6
Postcode : 57281 City : KAB. SRAGEN
State JAWA TENGAH Country : ID-INDONESIA
To Name : DAISY AND ANNA Importer's reference (if any) (Tax Code/VAT No/Importer Code)
EORI:
Address : 1 F ON NING BUILDING 425 431 KINGS ROAD NORTH
POINT MTR EXIT B HONGKONG
Address : Importer's telephone/fax/email :
57244697
Postcode 999077 City HONGKONG
DAISYANNA@GMAIL.COM
State HONG KONG Country HK-HONG KONG

For commersial item only

Net weight Total
Detailed description of contents Quantity Value Total Value Country of origin
(in kg) weight HS tarif number
of goods

PASSPORT 2 0,9 0,9 18.62 USD 18.62 USD 490199 Indonesia

Dimension (in Cm) Date of Posting

Category of item: ☑ Documents Weight
(in Kg) Length Width Height
24-02-2024 08:27

Sender’s instruction in case of non-delivery: Tarif

☑
Comments: I certificate that the particulars given in this
customs declaration are correct, and does not
contains any hazardous or prohibited item. I have
read and agree to the terms and conditions of
service that apply and also agree to pay the cost
related to my adjacent instructios in case of non-
License Certificate Invoice
delivery.
No(s) of license(s) No(s) of certificate(s) No(s) of invoice(s)
Date:
916-related document
(Shipper signature):