Tripli cate (PAGE 1 OF 2) 1. Products consigned from (Exporters business name, address, country) SHANCHAT HEJING IMPORT & EXPORT CO. LTD, Roo 22, 3F ( BUILDING B) , THE NEW BUND WORLD TRADE CENTER {( PHASE I.) NO.4, LANE 258 DONGYU ROAD, PUDONG. NEW DISTRICT SEANGEAL 200126 CHINA 2. Products consigned to (Consign PE, SANSAN SALDARATEX JAYA 'g name, address, country) JL. CTBALTGO NO. 38, CTVABT 40585, BANDING, INDONESIA TAK ID + 01, 280, 594, 1-421. 000 TEL: 62-22 6030788 EWAIL: SHPOZAPTSANSAN, CO, 1D" Reference No. H2SMAIGHLP¥L0008 ASEAN-CHINA FREE TRADE AREA PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM E Issued in THE PEOPLE’ S REPUBLIC OF CHINA (Country ‘See Overleat Notes. 5. Means of ransparl and route (as faras known) Departure date WAR. 31, 2023 Vessel’ name / Aircraftetc, XTC SURABAYA ¥ 23035 Port of Discharge JAKARTA, INDONESIA [FROM SIIANGIIAL, CILLNA TO JAKARTA, INDONESIA BY SEA 4, For Official Use Vorification:origin. customs. gov. en OF Preferential Treatment Given C Preferential Treatment Not Given (Please state reasons} Signature of Authorised Signatory of the Importing Party S.item _]6 Marks and ]7. Number and type of packages, description |. Onigineriteria].9.Grosa weight or nat | 10, Number, Number] numbers on | of products (including quantity where (see Overleat | weightor over quantty| date of packages | appropriate and HS. number in sx digit code) | Notes) fand value (FOB) only | Invoices when RVC eteron is applied 1 Nar INE_(I)_ PACKAGE OF FRONT AXIS. INCLUDE “RT 1SEr (suiecasna28 ISPROCKETSABUSHING WAR. 22, 2023 lis ‘cove: 8404. 10 2 pNE (1) PACKAGE OF REAR AXIS INCLUDE “pe ser ISPROCKETSABUSHING lis cope: 8404. 10 2 (1) PACKAGE OF BASE PLATE CHAIN GRATE] "PE" ser 3-6-0 lis cov: ‘8404. 10 4 [THREE (3) PACKAGES OF CHAIN GRATE 203 4 “ee 796 TECeS. (CODE: 8404. 10, 5 IREE (3) PACKAGES OF CHAIN GRATE 203 3 “ET 1736 LECES His cove: 8404.10 6 ONE. (1) PACKAGE OP JOIN CHAIN GRATE “pe 2p ices His cone: 104. 10 11, Declaration by the exporter ‘The undersigned hereby declares that the above details and statement are correct; that all the products wore produced in CHINA fai, China, APR. 04, 20 %, signature of authorised signatory 13, CF Exhibition 1D Third Party invoicing W Issued Retroactively 1D Movement Certificate 12, Certtieation TOU ALLO TR 2322000122075, : APR. 04, 2023 Place and date, signature and stamp of certifying authority 237200001244203Triplicate (Page 2 oF 2) 1. Products consigned from (Exporters business name, address, country) 2. Products consigned to (Consignee's name, address, country) Reference No. H2SMAIGHLP¥L0008 ASEAN-CHINA FREE TRADE AREA 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 Vesser's name / Aircraft ete ecereeere Port of Discharge 4, For Official Use Verification:origin. customs. gov. en 1 Preferential Treatment Given C Preferential Treatment Not Given (Please state reasons} Signature of Authorised Signatory ofthe Importing Party S.item _]6 Marks and ]7. Number and type of packages, description |. Onigineriteria].9.Grosa weight or nat | 10, Number, Number] numbers on | of products (including quantity where (see Overleat | weightor over quantty| date of packages | appropriate and HS. number in sx digit code) | Notes) fand value (FOB) only | Invoices when RVC eteron is applied 7 INE_(I) PACKAGE OF SIDE CHAIN GRATE L=64 “RT “496 TECES lis cove: 404.10 8 LLovc axis s26au “pe 2ASPIECES LENCLUDE:PINARING PLAT His Cope: 404.10 11, Declaration by the exporter ‘The undersigned hereby declares that the above details and statement are correct; that all the products wore produced in CHINA fai, China, APR. 04, 20 %, signature of authorised signatory 13, W Issued Retroactively 1D Movement Certificate CF Exhibition 1D Third Party invoicing 12, Certtieation TOU ALLO TR 2222000122075 : APR. 04, 2023 Place and date, signature and stamp of certifying authority 237200001244203