SHI
PT. Samudera Indonesia TBK.
Kami perusahaan yang bertanda tangan dibawah ini, m
benar. Kami juga menyatakan akan mematuhi semua p
penuh pihak kami,
SHIPPER/EXPORTER (COMPLETE NAME AND ADDRESS)
PT. Nusantara Ekspor Mandiri
Jl. Merdeka Raya No. 45, Jakarta Barat 11530, I
Telp: +62 21 7654321
CONSIGNEE (COMPLETE NAME AND ADDRESS)
Global Mart Pte. Ltd.
10 Anson Road, #35-05 International Plaza, Sin
Telp: +65 6123 4567
NOTIFY PARTY (COMPLETE NAME AND ADDRESS)
PT. Samudera Indonesia Tbk
Jl. Letjen S. Parman Kav. 35, Jakarta Barat 11480,
Telp: +62 21 5480088
PRE-CARRIAGE (EX VESSEL) MV Merdeka Jaya /
Voyage 118W
INTENDED VESEL/VOYAGE MV Samudera
Nusantara / Voyage 220E
PORT OF LOADING Jakarta, Indonesia
PER CNTR - CONTAINER
NO. / SEAL NOs. / MARKS &
NUMBERS
NO. OF PACKAGES / CNT
DESCRIPTION OF GOODS
(include HS code if applicable)
CARGO GROSS WEIGHT (KGS)
CARGO CUBIC
MEASUREMENT (M3) CNTR
GROSS WEIGHT (KGS)
Container No.: SMDU1234567
<br> Seal No.: 99887766 <br>
Marks: PT NEM 500 Cartons
Instant Coffee Mix (HS Code:
0901.21) 12,500 KGS 28.5 M3
13,200 KGS
Container No.: SMDU7654321
<br> Seal No.: 11223344 <br>
Marks: PT NEM 250 Bags Cocoa
Powder (HS Code: 1805.00)
7,800 KGS 20.2 M3 8,350 KGS
(Use separate sheet to continue above if more entry)
Signed:
Signatory is held out as having the authority of t
Company, which is also bound by completion and
signing of this form.
Tel nr: 6271827181
Fax nr: 7167161716
OOCL Conact: Not Applicable
For OOCL internal use only -
QF015 HQD 9/05
SHIPPING INSTR
mudera Indonesia TBK.
usahaan yang bertanda tangan dibawah ini, menyerahkan dokumen dasar
mi juga menyatakan akan mematuhi semua peraturan hukum .Segala risik
ak kami,
XPORTER (COMPLETE NAME AND ADDRESS)
ntara Ekspor Mandiri
ka Raya No. 45, Jakarta Barat 11530, Indonesia
21 7654321
E (COMPLETE NAME AND ADDRESS)
art Pte. Ltd.
n Road, #35-05 International Plaza, Singapore 079903
6123 4567
TY (COMPLETE NAME AND ADDRESS)
dera Indonesia Tbk
S. Parman Kav. 35, Jakarta Barat 11480, Indonesia
21 5480088
AGE (EX VESSEL) MV Merdeka Jaya /
W
VESEL/VOYAGE MV Samudera
Voyage 220E
OADING Jakarta, Indonesia
NO. OF
PACKAGE/CNTR
500 Cartons
250 Bags
300 Cartons
150 Drums
200 Sacks
120 Cartons
75 Rolls
60 Pallets
80 Crates
50 Boxes
400 Cartons
180 Bags
100 Drums
45 Pallets
600 Cartons
220 Boxes
90 Sacks
70 Crates
40 Rolls
55 Cartons
rate sheet to continue above if more entry)
Name: PT Samuder
is held out as having the authority of the. Company Name & Address:
which is also bound by completion and
this form.
6271827181
7167161716
onact: Not Applicable phone; 62718271
CL internal use only - Verification Ratin
QD 9/05
SHIPPING INSTRUCTION
nesia TBK.
tanda tangan dibawah ini, menyerahkan dokumen dasar ini sebagai dasar
kan akan mematuhi semua peraturan hukum .Segala risiko, kerugian, atau
ETE NAME AND ADDRESS)
Mandiri
5, Jakarta Barat 11530, Indonesia
E AND ADDRESS)
International Plaza, Singapore 079903
AME AND ADDRESS)
Tbk
35, Jakarta Barat 11480, Indonesia
PLACE OF RECEIPT Jakarta (Tanjung Priok Port)
CY Door CFS
PLACE OF DELIVERY ingapore – Consignee
Warehouse
PORT OF DISCHARGE Port of Singapore (PSA
Terminal)
DESCRIPTION OF GOODS ( include HTS code if applicable )
Instant Coffee Mix (HS Code: 0901.21)
Cocoa Powder (HS Code: 1805.00)
Packaged Noodles (HS Code: 1902.30)
Palm Oil (HS Code: 1511.90)
White Sugar (HS Code: 1701.99)
Biscuits & Cookies (HS Code: 1905.31)
Plastic Film Packaging (HS Code: 3920.20)
Bottled Mineral Water (HS Code: 2201.10)
Fresh Pineapples (HS Code: 0804.30)
Textile Garments (HS Code: 6203.42)
Canned Sardines (HS Code: 1604.13)
Rice (HS Code: 1006.30)
Crude Coconut Oil (HS Code: 1513.21)
Plywood Sheets (HS Code: 4412.39)
Instant Seasoning Powder (HS Code: 2103.90)
Shoes & Footwear (HS Code: 6403.59)
Coffee Beans (HS Code: 0901.11)
Bananas (HS Code: 0803.90)
Steel Pipes (HS Code: 7306.30)
Detergent Powder (HS Code: 3402.20)
tinue above if more entry)
Name: PT Samudera Indonesia T
having the authority of the. Company Name & Address: PT Samudera Indon
bound by completion and
1
16
pplicable phone; 62718271827
e only - Verification Rating OCR/IN
HIPPING INSTRUCTION
ni, menyerahkan dokumen dasar ini sebagai dasar penerbitan Bill of Lading
ua peraturan hukum .Segala risiko, kerugian, atau biaya tambahan akibat
VAT#
01.234.222.8-
0, Indonesia
VAT# 02.72812.999
Singapore 079903
VAT# 02.7278.99
80, Indonesia
OF RECEIPT Jakarta (Tanjung Priok Port)
or CFS
OF DELIVERY ingapore – Consignee
use
F DISCHARGE Port of Singapore (PSA
l)
SCRIPTION OF GOODS ( include HTS code if applicable )
Coffee Mix (HS Code: 0901.21)
Powder (HS Code: 1805.00)
ed Noodles (HS Code: 1902.30)
l (HS Code: 1511.90)
ugar (HS Code: 1701.99)
& Cookies (HS Code: 1905.31)
Film Packaging (HS Code: 3920.20)
Mineral Water (HS Code: 2201.10)
ineapples (HS Code: 0804.30)
Garments (HS Code: 6203.42)
Sardines (HS Code: 1604.13)
S Code: 1006.30)
Coconut Oil (HS Code: 1513.21)
d Sheets (HS Code: 4412.39)
Seasoning Powder (HS Code: 2103.90)
& Footwear (HS Code: 6403.59)
Beans (HS Code: 0901.11)
s (HS Code: 0803.90)
pes (HS Code: 7306.30)
nt Powder (HS Code: 3402.20)
y)
Name: PT Samudera Indonesia Tbk
of the. Company Name & Address: PT Samudera Indonesia Tbk, Jakarta Barat 11
and
phone; 62718271827 fax
Verification Rating OCR/INPUT QC1
STRUCTION
n dasar ini sebagai dasar penerbitan Bill of Lading. Informasi yang tercan
gala risiko, kerugian, atau biaya tambahan akibat ketidakpatuhan akan me
BOOKING NO. BKG-2025-009887
EXPORTER'S REG. NO. 09.2025.7786
FORWARDING AGENT - REFERENCE; PT. Citra Logistik
TYPE OF BL Original
Sea Waybill
INTERNET BL REQ'D (Y/N)
FREIGHT Prepaid by: Shipper
Collect by: Consignee
CHARGES
at Origin payable by: Shipper
at Destination payable by: Consignee
OTHER / SPECIAL INSTRUCTION(S): – Fragile cargo, h
– Keep container dry & upright
– Notify consignee immediately upon vessel a
TS code if applicable ) CARGOGROSS
WEIGHT/CNTR
1.21) 12,500
0)
2.30) 7,800
6,000
05.31) 18,500
3920.20) 10,000
2201.10)
30)
3,200
42) 2,500
13)
9,000
3.21) 4,800
39) 1,200
de: 2103.90)
3.59) 8,600
5,500
19,000
2.20) 15,200
7,400
2,900
amudera Indonesia Tbk Date:
Address: PT Samudera Indonesia Tbk, Jakarta Barat 11470 – Indonesia
718271827 fax; 6281728171
Rating OCR/INPUT QC1 QC2
of Lading. Informasi yang tercantum telah diisi dengan
n akibat ketidakpatuhan akan menjadi tanggung jawab
CUSTOMS ENTRY / REF. CUS-REF-6768767
2025.7786
EFERENCE; PT. Citra Logistik VAT# 01.273.888
No. of Original 3 No. of Copy 2
BL DRAFT CFMN (Y/N) Y
paid by: Shipper
lect by: Consignee
e by: Shipper
estination payable by: Consignee
L INSTRUCTION(S): – Fragile cargo, handle with care
– Keep container dry & upright
y consignee immediately upon vessel arrival
CARGO CUBIC (M3) CNTR GROSS WT/CNTR
28.5 13,200
20.2 8,350
15.0 6,500
25.4 19,200
18.8 10,700
9.5 3,600
7.2 2,900
22.5 9,500
12.4 5,200
6.8 1,600
19.7 9,300
14.8 6,100
23.5 19,700
31.0 15,900
11.6 8,000
8.4 3,500
Date: 23/08/2025
a Barat 11470 – Indonesia
fax; 6281728171
C1 QC2
lah diisi dengan
anggung jawab
8/2025
