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Receipt Booking

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PT POS INDONESIA (Persero) CUSTOMS DECLARATION CN 23

From Sender customs reference No. of item (barcode, if


Name : Ria wahyunita NIK-1806135408940001 | Maybe opened officially
De any)
Address : Sumberejo DECLARATION EN DOUANE
No. of item (barcode, if | Maybe opened officially
Address (count)
any)
Postcode : 35662 City : KAB. TANGGAMUS
State LAMPUNG Country : ID-INDONESIA Declaration ID
To Name : Travis touchdown C D S 0 3 2 3 8 6 5 3 7 0
A
Address : 19 jalan Meranti 3 40000 Shah alam Importer's references (if any) {tax code/VAT No./importer code) (optional)
Address (count)
Postcode 40000 City SHAH ALAM 596508 Importer's telephone/fax/email (if known)
State MALAYSIA Country MY-MALAYSIA 60123656381 brainmistake@gmail.com

Net weight (3) For commersial item only


Detailed description of contents (1) Quantity (2) Total weight (4) Value (5) Total Value (6)
(in kg) HS tarif number (7) Country of origin of goods (8)
Black Coffee 1 5,0 5,0 19.12 USD 19.12 USD 210111
Category of item (10) X Sales of goods Commercial sample Office origin/Date of posting
Gift Returned Goods Other
22/03/2023 18:07
Documents Mixed content
Comments (11) : (e.g goods subject to quarantine, sanitary/phytosanitary inspection or other restriction) I certify that the particulars given in this custom
declaration are correct and that this item does not
contain any dangerous article or articles prohibited by
legisation or by postal or customs regulations
Licence (12) Certificate (13) Invoice (14) Date and sender's signature (15)
No(s). of licence(s) No(s). of certificate(s) No(s). of invoice 22/03/2023 18:07

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