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TC Fca

1. The document is a Certificate of Origin from HD Fire Protect Pvt Ltd in India to PT TRIMITRA WUJUD REKANUSA in Indonesia. 2. It certifies that 486 kg of foam chamber water spray nozzles were produced in India and meet the origin requirements for export to Indonesia. 3. The International Chamber of Commerce verifies and signs that the exporter's declaration of Indian origin is correct based on controls carried out.

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Reinhard Simbolon
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86 views17 pages

TC Fca

1. The document is a Certificate of Origin from HD Fire Protect Pvt Ltd in India to PT TRIMITRA WUJUD REKANUSA in Indonesia. 2. It certifies that 486 kg of foam chamber water spray nozzles were produced in India and meet the origin requirements for export to Indonesia. 3. The International Chamber of Commerce verifies and signs that the exporter's declaration of Indian origin is correct based on controls carried out.

Uploaded by

Reinhard Simbolon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CERTIFICATE OF ORIGIN (NON PREFERENTIAL)

(COMBINED DECLARATION AND CERTIFICATE ISSUED IN INDIA)


1. Goods consigned from (exporter's business name, address, Reference No:93355 IMC Code No: IMC1946
country)

HD FIRE PROTECT PVT LTD


K-96, K-97/1, K97/2, K-98, MIDC & GAT336,
AJANTA ROAD,JALGAON-425 003, MAHARASHTRA
GST: 27AABCD0020D1ZK Head Office: IMC Bldg., IMC Marg, Churchgate, Mumbai -
IE No: 0397055404 DT 13.10.1997 400 020 India. Tel : +91-22-71226633, Email : imc@imcnet.org

2. Goods consigned to (consignee's business name, address, Branch Office: 616/617, The Commodity Exchange Bldg, IMC
country) Marg, Sector 19A, Vashi, Navi Mumbai 400705, Tel: +91-22-
27842467, Fax: +91-22-27842467 Mail: imcvashi@imcnet.org
PT TRIMITRA WUJUD REKANUSA
JL Gunung Sahari Raya 51/8, Jakarta Pusat, Jakarta Branch Office: 405, Centre Square, A-Wing, 4th Floor, S. V.
10610,Indonesia Tel : 62 21 42276332 Road, Andheri (West) Mumbai 400 058, Tel: +91-22-26231937,
Indonesia Fax : +91-22-26703689 Mail: imcandheri@imcnet.org

3. Means of transport / Port of loading & discharge Branch Office: 16A, 16th Floor, Atma Ram House, 1-Tolstoy
Marg, New Delhi - 110001, Tel: +91-11-23730978, Fax: +91-11-
Air
23730979, Mail: imcdelhi@imcnet.org
MUMBAI,INDIA
JAKARTA,INDONESIA
4. For Office use (IMC):

5. 6. Marks and No of packages 7. Description of goods 8. Origin 9. Weight or 10. Invoice


Item Criteria other quantity
Invoice No:
No. PT.TRIMITRA (01) WOODEN PALLET & (04) CARTONS.
J1/J2, TOTAL (05) PKGS India Gross Weight: JE23-24/280-
T1/T3 486.00 TE23-24/185
1 INDONESIA Foam Chamber, Net Weight: Invoice Date:
Water Spray Nozzle 398.30 10-10-2023
Weight In: KGS
HS CODE: 8424.90.2900, 8424.90.29

11. CERTIFICATION (IMC) 12. DECLARATION BY THE EXPORTER


It is hereby certified on the basis of control carried out, that The undersigned hereby declares that the above details &
the declaration by the exporter is correct statements are correct that all goods were produced in India
(Name of Country) and that they comply with the origin
requirements for exports to Indonesia (Name of Importing
Country)
Digitally Signed
12th Oct 2023

Authorised Signatory - IMC Chamber of Commerce and THANE/12.10.2023


Industry. Place & Date, Exporters Signature, Rubber Stamp of Co.

This is a digitally signed document verified by (Ajay T. Shinde - Verification officer of IMC) and does not require sign and stamp.

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