KSO SUCOFINDO - SURVEYOR INDONESIA
LAPORAN SURVEYOR
                                                                            (SURVEYOR REPORT)
                                                            Impor Pakaian Jadi dan Aksesoris Pakaian Jadi
                                                              (Import of Garments and Garment Accessories)
                                                            LS No. B0825CN4800043     VO No. X.48.024285 P1
I. Parties Concerned /         Pihak - Pihak Terkait
  Importer /        Importir
   Name /     Nama
                                                        :     PT. INDO TAMAR SEMBADA
   Address /       Alamat
                                                        :     JL RAYA PENGGILINGAN NOMOR 10 BIZ PARK 2 BLOK A/6, CAKUNG
                                                              DESA/KELURAHAN PENGGILINGAN, KEC. CAKUNG
   City /   Kota                                        :     JAKARTA TIMUR, DKI JAKARTA 13940
   NPWP                                                 :     0028319366004000
   API/NIB                                              :     1412220063413
   PI/IP/IT                                             :     04.PI-68.25.0221
   Expiry PI/IP/IT /    Tanggal Berakhir PI/IP/IT       :     31 DEC 2025
  Exporter /       Eksportir
   Name /     Nama
                                                        :     NIKE GLOBAL TRADING B.V. SINGAPORE BRANCH
   Address /       Alamat
                                                        :     30 PASIR PANJANG ROAD # 10-31/32 MAPLETREE BUSINESS CITY , SINGAPORE 117440
   Country /       Negara                               :     SINGAPORE
II. Shipment Data /         Data Pengapalan
  Mode of Transportation / Moda Transportasi :                SEA                           Invoice / Invoice                            :     4302061267, *)
  Port of Loading / Pelabuhan Muat                      :     YANTIAN                       Place of Verification / Tempat Verifikasi :          YANTIAN PT
  Port of Discharge / Pelabuhan Bongkar                 :     TANJUNG PRIOK                 Date of Verification / Tanggal Verifikasi :          19 FEB 2025
  Total Net Weight / Total Berat Bersih                 :     575.5400 KGM
III. Details of Goods Verified /           Detail Verifikasi Barang
  Marks and Numbers of Packing /                    Keterangan dan Jumlah Kemasan                       Quantity and Type of Packing /             Jumlah dan Jenis Kemasan
  MARKS:                                                                                                102 CARTONS
  <1034>
  TO:
  JAKARTA, JAVA, JK
  INDONESIA
  COUNTRY OF ORIGIN:
  CHINA
  -
  *) INVOICE NO. (CONTINUED):
  4302061268, 4302061270, 4302067445
  4302067447, 4302067449, 4302067455
  4302042754, 4302042758, 4302042761
  4302054580, 4302054581, 4302054582
  4302067119, 4302078443, 4301817382
  4302068946
   No.        HS Code             Description of Goods                                                                            Quantity / UoM                    Origin
              Kode HS             Uraian Barang                                                                                    Jumlah / Satuan                Negara Asal
                                            Peraturan Menteri Perdagangan Republik Indonesia No. 36 TAHUN 2023
                                              Regulation of the Minister of Trade of The Republic of Indonesia No. 36 TAHUN 2023
   Laporan ini merupakan hasil cetak dokumen elektronik. Laporan ini diterbitkan dalam rangka memenuhi persyaratan yang ditetapkan oleh Pemerintah Republik Indonesia dan tidak
                                membebaskan pihak-pihak terkait dari tanggung jawabnya terhadap ketentuan perundang-undangan Republik Indonesia
   (The report is printed electronic document. This report is published in order to comply with the requirements implemented by the Government of the Republic of Indonesia and not to
                                        release the related parties from their responsibility for the provisions of the laws of the Republic of Indonesia)
                                                              KSO CODE: 48bepr250303172913O                                                                                      Page. 1
                                                    KSO SUCOFINDO - SURVEYOR INDONESIA
                                                            LAPORAN SURVEYOR
                                                                        (SURVEYOR REPORT)
                                                    Impor Pakaian Jadi dan Aksesoris Pakaian Jadi
                                                      (Import of Garments and Garment Accessories)
                                                    LS No. B0825CN4800043     VO No. X.48.024285 P1
1.      6204.53.00           CULOTTES, WOVEN, MATERIAL: 100% NYLON, WOMENS, STYLE NO:                                            33.0000 PCE                      CHINA
                             HM6980-010/AS W NSW ESSNTL WVN MR 3" SKO, SIZE: XS-XL, BRAND: NIKE,
                             PACKED IN 5 CARTONS
2.      6203.43.00           SHORTS, WOVEN, MATERIAL: 94% NYLON 6% SPANDEX, MENS, STYLE NO:                                      63.0000 PCE                      CHINA
                             IB7552-299/AS U NK DF KEARNY CRGO SHORT O, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 5 CARTONS
3.      6203.43.00           SHORTS, WOVEN, MATERIAL: 94% NYLON 6% SPANDEX, MENS, STYLE NO:                                      63.0000 PCE                      CHINA
                             IB7552-204/AS U NK DF KEARNY CRGO SHORT O, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 5 CARTONS
4.      6203.43.00           PANTS, WOVEN, MATERIAL: 96% NYLON 4% ELASTANE, MEN'S, STYLE NO:                                     130.0000 PCE                     CHINA
                             FN0429-010/AS M ACG SMITH SUMMIT CRG PANT, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 10 CARTONS
5.      6204.62.00           PANTS, WOVEN, MATERIAL: 100% COTTON, WOMEN'S, STYLE NO:                                             90.0000 PCE                      CHINA
                             FV7098-010/W J FLT CHICAGO PANT 24, SIZE: XS-2XL, BRAND: NIKE, PACKED
                             IN 9 CARTONS
6.      6202.40.90           JACKET, WOVEN, MATERIAL: 100% NYLON, WOMEN'S, STYLE NO:                                             66.0000 PCE                      CHINA
                             HJ0177-084/AS W NSW STREET WVN JKT, SIZE: XS-XL, BRAND: NIKE, PACKED
                             IN 6 CARTONS
7.      6201.40.90           JACKET, WOVEN, MATERIAL: 94% NYLON 6% ELASTANE, MEN'S, STYLE NO:                                    108.0000 PCE                     CHINA
                             HM7152-539/AS M NK TCH WVN WR FZ JKT, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 7 CARTONS
8.      6201.40.90           JACKET, WOVEN, MATERIAL: 94% NYLON 6% ELASTANE, MEN'S, STYLE NO:                                    44.0000 PCE                      CHINA
                             HM7152-010/AS M NK TCH WVN WR FZ JKT, SIZE: S-XL, BRAND: NIKE,
                             PACKED IN 4 CARTONS
9.      6201.40.90           JACKET, WOVEN, MATERIAL: 94% NYLON 6% ELASTANE, MEN'S, STYLE NO:                                    183.0000 PCE                     CHINA
                             HM7152-065/AS M NK TCH WVN WR FZ JKT, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 11 CARTONS
10.     6201.40.90           JACKET, WOVEN, MATERIAL: 94% NYLON 6% ELASTANE, MEN'S, STYLE NO:                                    183.0000 PCE                     CHINA
                             HM7152-320/AS M NK TCH WVN WR FZ JKT, SIZE: S-2XL, BRAND: NIKE,
                             PACKED IN 11 CARTONS
11.     6204.63.00           PANTS, WOVEN, MATERIAL: 83% POLYESTER 17% ELASTANE, WOMEN'S,                                        165.0000 PCE                     CHINA
                             STYLE NO: HQ0236-104/AS W NK 24.7 DF HR WD LEG PANT, SIZE: XS-XL,
                             BRAND: NIKE, PACKED IN 5 CARTONS
12.     6204.63.00           PANTS, WOVEN, MATERIAL: 83% POLYESTER 17% ELASTANE, WOMEN'S,                                        74.0000 PCE                      CHINA
                             STYLE NO: HQ0236-010/AS W NK 24.7 DF HR WD LEG PANT, SIZE: XS-XL,
                             BRAND: NIKE, PACKED IN 5 CARTONS
13.     6206.40.00           SHIRTS, WOVEN, MATERIAL: 83% POLYESTER 17% ELASTANE, WOMEN'S,                                       24.0000 PCE                      CHINA
                             STYLE NO: HQ0237-701/AS W NK 24.7 DF LS SHIRT WVN, SIZE: M-XL, BRAND:
                             NIKE, PACKED IN 3 CARTONS
14.     6205.30.90           SHIRTS, WOVEN, MATERIAL: 100% POLYESTER, MEN'S, STYLE NO:                                           60.0000 PCE                      CHINA
                             HJ2959-133/AS U NK SB DF BOWLER2 WVN SS, SIZE: S-XL, BRAND: NIKE,
                             PACKED IN 4 CARTONS
15.     6203.43.00           SHORTS, WOVEN, MATERIAL: 94% NYLON 6% ELASTANE, MEN'S, STYLE NO:                                    192.0000 PCE                     CHINA
                             HQ0471-010/AS M NK TECH WVN SHORT, SIZE: S-2XL, BRAND: NIKE, PACKED
                             IN 7 CARTONS
16.     6109.10.10           T-SHIRT, KNITTED, MATERIAL: 59% COTTON 41% POLYESTER, MENS, STYLE                                   24.0000 PCE                      CHINA
                             NO: FJ2363-010/AS M NK DF TEE HERITAGE, SIZE: S-XL, BRAND: NIKE,
                             PACKED IN 1 CARTON
17.     6109.10.10           T-SHIRT, KNITTED, MATERIAL: 100% COTTON, MENS, STYLE NO:                                            29.0000 PCE                      CHINA
                             AR5005-474/AS M NSW TEE ICON FUTURA, SIZE: S-XL, BRAND: NIKE, PACKED
                             IN 4 CARTONS
                                                                                                                                  Place and Date of Issuance / Tempat dan Tanggal Terbit
                                                                                                                                                             JAKARTA, 03 MAR 2025
                                       Peraturan Menteri Perdagangan Republik Indonesia No. 36 TAHUN 2023
                                          Regulation of the Minister of Trade of The Republic of Indonesia No. 36 TAHUN 2023
Laporan ini merupakan hasil cetak dokumen elektronik. Laporan ini diterbitkan dalam rangka memenuhi persyaratan yang ditetapkan oleh Pemerintah Republik Indonesia dan tidak
                             membebaskan pihak-pihak terkait dari tanggung jawabnya terhadap ketentuan perundang-undangan Republik Indonesia
(The report is printed electronic document. This report is published in order to comply with the requirements implemented by the Government of the Republic of Indonesia and not to
                                     release the related parties from their responsibility for the provisions of the laws of the Republic of Indonesia)
                                                        KSO CODE: 48bepr250303172913O                                                                                           Page. 2