CH H7D4W3I
THE REPUBLIC OF INDONESIA
INDONESIAN QUARANTINE AUTHORITY
HEALTH CERTIFICATE FOR LIVE AQUATIC ANIMAL NOT FOR HUMAN CONSUMPTION
Ref. Number: 2025-I1.0-1301.0-K.I.1-000018
Description of Animals/Deskripsi Hewan :
No Common Name/Nama Umum Scientific Name/Nama Ilmiah Quantity/Jumlah Unit
- --see appendix -- --see appendix -- -- --
Total: 1,920.00 head
1. Consignor / Pengirim barang 2. Competent authority/Otoritas kompeten:
Name / Nama : CV. BESPI SAMUDERA AQUATIC INDONESIA QUARANTINE AGENCY OF
Address / AlamatJL. LINTAS PADANG-PAINAN, KOMPLEK PELABUHAN WEST SUMATERA
PERIKANAN SAMUDERA BUNGUS, BUNGUS TELUK KABUNG, KOTA PADANG,
SUMATERA BARAT
3. Consignee / Penerima barang
Name / Nama : Guangdong Lanhai Marine Technology Co.,Ltd
Address / Alamat : No. 4-2 Longxi Panlong Village, Hailong Street, Liwan District, Guangzhou City
4. Aquaculture establishment/Unit Usaha Budidaya Fish Processing establishment/Unit Pengolahan Ikan
Others / Lainnya
Name / Nama : CV. BESPI SAMUDERA AQUATIC
Address (detailed) / Alamat lengkap: JL. LINTAS PADANG-PAINAN, Establishment ID Number / No Registrasi: 2-CHN-
KOMPLEK PELABUHAN PERIKANAN SAMUDERA BUNGUS, BUNGUS 044
TELUK KABUNG, KOTA PADANG, SUMATERA BARAT
5. Capture area (only for wild) / Area tangkapan (khusus hasil tangkapan):
6. Country and region of origin / Negara dan daerah 7. Source / Sumber
asal: INDONESIA farm-raised / budidaya wild-caught / tangkap
8. Port of shipment / Pelabuhan pengeluaran: 9. Means of transport / Alat transportasi:
Minangkabau Airport aeroplane/angkutan udara ship/angkutan laut
road vehicle/angkutan darat
10. Description of commodity / Deskripsi komoditas: 11. Total number of packages, associated batch numbers
Marine Water Ornamental Fish and number of packages per batch / Jumlah kemasan total
terkait nomor batch dan kemasan per batch
70 Box
*(information on batch see attachment if insufficient /
informasi tentang batch dapat dilihat pada lampiran jika
kolom tidak cukup )
12. Type of packaging / Jenis kemasan: Box 13. Total quantity (kg) / Jumlah total (kg):100.00
14. Identification of container/seal number / Identifikasi container/nomor segel: == 15. Port of destination/Pelabuhan tujuan:
Guangzhou
16. Identification of transport / Identitas alat transport 17. Date of departure / Tanggal pengiriman:2025-03-01
Name of vessel / Nama kapal : AIRPLANE
Voyage number / Nomor penerbangan : AIR CARGO
18. Testing laboratory / Laboratorium penguji :Animal, Fish, and Address / Alamat :Jln. Bandara Internasional
Plant Quarantine Authority of West Sumatera Minangkabau, Padang Pariaman, Indonesia
19. Approving officer name / Penanggungjawab laboratorium:
Mardika Imaputra, S.Pi
20. Testing report number / Nomor laporan hasil uji :
543/BKHIT.KI/PL/II/2025-CKIB Signature / tanda tangan: SARBEN, S.PI.
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Ref Number: 2025-I1.0-1301.0-K.I.1-000018
Attestation
The undersigned Certifying Official certifies that the animal(s) / Pejabat penandatangan sertifikat di bawah ini menyatakan
bahwa hewan
Finfish / Ikan bersirip Mollusca / Moluska Crustacea / Krustasea Fish products / Produk ikan Others / Lainnya
described above satisfy(ies) the following requirements / yang diuraikan di atas memenuhi persyaratan berikut:
a. The animal(s) described above is (are) from the farm that has (have) been approved and officially supervised by
Indonesian Quarantine Authority (IQA)/ Hewan yang diuraikan d atas berasal dari unit budidaya yang telah disetujui dan
diawasi secara resmi oleh Badan Karantina lndonesia.
b. The animal(s) is (are) originated from a source where the following diseases are notifiable to the competent authority
infection with epizootic haematopoietic necrosis virus (EHNV), infection with infectious salmon anaemia virus (ISAV),
infection with viral haemorrhagic septicaemia virus (VHSV), infection with infectious haematopoietis necrosis (IHN), and
infection with koi herpesvirus (KHV)/ Hewan berasal dari sumber yang mengharuskan peneman penyakit berikut
dilaporkan kepada pihak yang berwenang:
infection with epizootic haematopoietic necrosis virus (EHNV), infection with infectious salmon anaemia virus (ISAV),
infection wth viral haemorrhagic septicaemia virus (VHS), infection with infectious haematopoetic necrosis (IHN), dan
infection with koi herpesvirus (KHV)
c. The animal(s) has (have) been handled, prepared or processed, identified, stored and transported under a competent
HACCP and sanitary programme consistently implemented and in accordance with the requirements laid down in Codex
Code of Practice for Fish and Fishery Products (CAC/RCP 52-2003) / hewan telah ditangani, disiapkan atau diproses,
diidentifikasi, disimpan dan ditransportasikan sesuai persyaratan sanitasi dan HACCP yang diterapkan secara konsisten
dan sesuai dengan persyaratan yang ditetapkan Codex Code of Practice for Fish and Fishery Products (CAC / RCP 52-
2003)
d. The disease surveillance has been implemented by IQA in the farm of origin for at least 2 years, and no detection of
specific disease in last 6 months before exporting /Surveilans penyakit telah dilaksanakan oleh Barantin di unit budidaya
asal sekurang-kurangnya selama 2 tahun, dan tidak ditemukan adanya penyakit tertentu dalam 6 bulan terakhir sebelum
diekspor
e. The animal(s) has (have) been found post-processing to be free of disease based on sampling and testing method
recognized by the World Organization for Animal Health (OIE) for demonstrating absence of disease and inspected
according to the appropriate procedures and subsequently found, at the time of inspection / Hewan pasca pengolahan
bebas dari penyakit berdasarkan pengambilan sampel dan metode pengujian yang dakui oleh World Organization for
Animal Health (OIE) dan pada saat pemeriksaan
to be free from diseases / bebas dari penyakit : Iridovirus
to show no visible/clinical signs of diseases / tidak menunjukkan gejala penyakit secara visual/klinis : All infectious
diseases
f. The animal(s) has (have) been inspected within 48 hours prior to the signing of this certificate, and showed no clinical
signs of disease / Hewan telah dinspeksi dalam waktu 48 jam sebelum penandatanganan sertifikat ini dan tidak
menunjukkan gejala klinis penyakit
g. The animal(s) has (have) been handled, prepared, stored, and transported based on biosecurity principles / Hewan telah
ditangan, disiapkan, disimpan, dan diangkut sesuai dengan prinsip-prinsip biosekuriti
h. Immediately before transport, the animal(s) / Sesaat sebelum diangkut, hewan tersebut
is (are) placed in water of a quality that does not alter their health status / ditempatkan di air dengan kualitas yang tidak
mengubah status kesehatan mereka, : -
is (are) placed in sealed watertight containers which are new, or have been cleaned and disinfected beforehand, which
bear on the exterior a legible label with the relevant information / ditempatkan dalam wadah kedap air tertutup yang baru,
atau telah dibersihkan dan didesinfeksi sebelumnya, yang di bagian luarnya terdapat label yang dapat dibaca dengan
informasi yang relevan : -
The certificate is valid for 7 (seven) days form date of issue / Sertifikat ini berlaku 7 (tujuh) hari sejak tanggal dikeluarkan.
CERTIFIED DETAILS / Detail penerbit sertifikat
Issued at PADANG PARIAMAN on
Name / Nama : SARBEN, S.PI. February 27 2025
Certifying body :
Position / Jabatan : PENGENDALI HAMA DAN PENYAKIT IKAN AHLI MUDA
Issued at / Lokasi : PADANG PARIAMAN
Phone / Telepon : 0751-62560
Stamp / Stempel
Fax / Faksimili : 0751-62560
E-mail / Surat elektronik : karantinasumbar@karantinaindonesia.go.id AUTHORIZED
Jl. Sutan Syahrir No. 267, Mata Air, Padang, Sumatera STAMP
Address / Alamat :
Barat, Indonesia
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APPENDIX:
HEALTH CERTIFICATE FOR FISH AND FISH PRODUCT
No: 2025-I1.0-1301.0-K.I.1-000018
DESCRIPTION OF CONSIGNMENT
Name and quantity of product:
No Common Name/Nama Umum Scientific Name/Nama Ilmiah Quantity/Jumlah Unit
1 POMACENTRIDAE POMACENTRIDAE 600 head
2 ACANTHURIDAE ACANTHURIDAE 800 head
3 POMACANTHIDAE POMACANTHIDAE 120 head
4 LABRIDAE LABRIDAE 100 head
5 CHAETODONTIDAE CHAETODONTIDAE 50 head
6 SERRANIDAE SERRANIDAE 250 head
Total: 1,920.00 head
PADANG PARIAMAN, February
27 2025
Pejabat Karantina Ikan
SARBEN, S.PI.
NIP.197312312002121010
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