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    Certificate of Origin: (Country)

    Uploaded by

    CUSTOMS LBJ
    1. This document is a Certificate of Origin for goods being shipped from PT Langgeng Buana Jaya in Indonesia to Disney Theme Park Merchandise Distribution Center in the United States. 2. The goods being shipped include 4 items: Statue figurines of Ariel, Belle, Groot, and Darth Vader. 3. The certificate certifies that the goods were produced in Indonesia and meet the origin requirements to qualify for preferential tariff treatment under the US Generalized System of Preferences program.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Certificate of Origin: (Country)

    Uploaded by

    CUSTOMS LBJ
    318 views5 pages
    1. This document is a Certificate of Origin for goods being shipped from PT Langgeng Buana Jaya in Indonesia to Disney Theme Park Merchandise Distribution Center in the United States. 2. The goods being shipped include 4 items: Statue figurines of Ariel, Belle, Groot, and Darth Vader. 3. The certificate certifies that the goods were produced in Indonesia and meet the origin requirements to qualify for preferential tariff treatment under the US Generalized System of Preferences program.

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    1. This document is a Certificate of Origin for goods being shipped from PT Langgeng Buana Jaya in Indonesia to Disney Theme Park Merchandise Distribution Center in the United States. 2. The goods being shipped include 4 items: Statue figurines of Ariel, Belle, Groot, and Darth Vader. 3. The certificate certifies that the goods were produced in Indonesia and meet the origin requirements to qualify for preferential tariff treatment under the US Generalized System of Preferences program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    318 views5 pages

    Certificate of Origin: (Country)

    Uploaded by

    CUSTOMS LBJ
    1. This document is a Certificate of Origin for goods being shipped from PT Langgeng Buana Jaya in Indonesia to Disney Theme Park Merchandise Distribution Center in the United States. 2. The goods being shipped include 4 items: Statue figurines of Ariel, Belle, Groot, and Darth Vader. 3. The certificate certifies that the goods were produced in Indonesia and meet the origin requirements to qualify for preferential tariff treatment under the US Generalized System of Preferences program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    116897754159

    1. Goods consigned from ( exporter's business name, address, Reference No. 0000748/GRS/2022
    country)
    PT LANGGENG BUANA JAYA
    VETERAN MADYA NO.8
    INDONESIA GENERALIZED SYSTEM OF PREFERENCES
    CERTIFICATE OF ORIGIN
    2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)

    DISNEY THEME PARK MERCHANDISE FORM A


    DISTRIBUTION CENTER BUILDING 100
    Issued in INDONESIA
    1020 W. BALL ROAD ANAHEIM, CA 92803
    (country)
    UNITED STATES OF AMERICA

    See notes overleaf

    3. Means of transport and route (as far as known) 4. For official use

    SHIPPED BY : FOLEGANDROS 146N ISSUED RETROSPECTIVELY

    FROM : SURABAYA (PTT)

    TO : LOS ANGELES

    DATE OF : NOVEMBER 25, 2021


    SHIPMENT

    5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
    num- numbers of criterion or other and date of
    ber packages (see notes quantity invoices
    overleaf)
    1 MADE IN INDONESIA 9 CT W 9503 864 PCE 489B/EXP.LBJ/11
    TOTAL : 837 PO NO.: L-4061200 960810 93.03 KGM 21
    CARTONS DISNEY ITEM : 400932913360 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q321U027 2021
    STAT321 PEN ARIEL
    864 PCS / 9 CTNS

    2 9 CT W 9503 864 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 93.6 KGM 21
    DISNEY ITEM : 400932913377 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q321U028 2021
    STAT321 PEN BELLE
    864 PCS / 9 CTNS

    3 13 CT W 9608 1,248 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 90.23 KGM 21
    DISNEY ITEM : 400932913384 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q321U030 2021
    STAT321 PEN GROOT
    1248 PCS / 13 CTNS

    4 9 CT W 9608 864 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 113.18 KGM 21
    DISNEY ITEM : 400932913391 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q321U031 2021
    STAT321 PEN DVADER
    864 PCS / 9 CTNS

    11. Certification 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 and
    the declaration by the exporter is correct. statements are correct; that all the goods were
    INDONESIA
    produced in ..............................................................................
    ISSUING OFFICE IN KABUPATEN GRESIK (country)
    and that they comply with the origin requirements specified
    for those goods in the generalized system of preferences for
    goods exported to

    UNITED STATES OF AMERICA


    ..................................................................................................
    AGUS BUDIONO (importing country)
    GRESIK, JANUARY 24, 2022 GRESIK, JANUARY 24, 2022
    ..................................................................................................... ..................................................................................................
    Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory

    Page 1 / 5
    116897754159

    1. Goods consigned from ( exporter's business name, address, Reference No. 0000748/GRS/2022
    country)
    PT LANGGENG BUANA JAYA
    VETERAN MADYA NO.8
    INDONESIA GENERALIZED SYSTEM OF PREFERENCES
    CERTIFICATE OF ORIGIN
    2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)

    DISNEY THEME PARK MERCHANDISE FORM A


    DISTRIBUTION CENTER BUILDING 100
    Issued in INDONESIA
    1020 W. BALL ROAD ANAHEIM, CA 92803
    (country)
    UNITED STATES OF AMERICA

    See notes overleaf

    3. Means of transport and route (as far as known) 4. For official use

    SHIPPED BY : FOLEGANDROS 146N ISSUED RETROSPECTIVELY

    FROM : SURABAYA (PTT)

    TO : LOS ANGELES

    DATE OF : NOVEMBER 25, 2021


    SHIPMENT

    5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
    num- numbers of criterion or other and date of
    ber packages (see notes quantity invoices
    overleaf)
    5 9 CT W 9608 864 PCE 489B/EXP.LBJ/11
    PO NO.: L-4061200 960810 154.39 KGM 21
    DISNEY ITEM : 400941265344 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q122U004 2021
    STAT122 FIGPEN BEAST
    864 PCS / 9 CTNS

    6 9 CT W 9608 864 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 118.63 KGM 21
    DISNEY ITEM : 400941265351 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q122U005 2021
    STAT122 FIGPEN BUZZ
    864 PCS / 9 CTNS

    7 9 CT W 9608 864 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 86.52 KGM 21
    DISNEY ITEM : 400941265368 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q122U006 2021
    STAT122 FIGPEN SALLY
    864 PCS / 9 CTNS

    8 9 CT W 9608 864 PCE 489B/EXP.LBJ/11


    PO NO.: L-4061200 960810 235.79 KGM 21
    DISNEY ITEM : 400941265375 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q122U007 2021
    STAT122 FIGPEN CHEWY
    864 PCS / 9 CTNS

    11. Certification 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 and
    the declaration by the exporter is correct. statements are correct; that all the goods were
    INDONESIA
    produced in ..............................................................................
    ISSUING OFFICE IN KABUPATEN GRESIK (country)
    and that they comply with the origin requirements specified
    for those goods in the generalized system of preferences for
    goods exported to

    UNITED STATES OF AMERICA


    ..................................................................................................
    AGUS BUDIONO (importing country)
    GRESIK, JANUARY 24, 2022 GRESIK, JANUARY 24, 2022
    ..................................................................................................... ..................................................................................................
    Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory

    Page 2 / 5
    116897754159

    1. Goods consigned from ( exporter's business name, address, Reference No. 0000748/GRS/2022
    country)
    PT LANGGENG BUANA JAYA
    VETERAN MADYA NO.8
    INDONESIA GENERALIZED SYSTEM OF PREFERENCES
    CERTIFICATE OF ORIGIN
    2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)

    DISNEY THEME PARK MERCHANDISE FORM A


    DISTRIBUTION CENTER BUILDING 100
    Issued in INDONESIA
    1020 W. BALL ROAD ANAHEIM, CA 92803
    (country)
    UNITED STATES OF AMERICA

    See notes overleaf

    3. Means of transport and route (as far as known) 4. For official use

    SHIPPED BY : FOLEGANDROS 146N ISSUED RETROSPECTIVELY

    FROM : SURABAYA (PTT)

    TO : LOS ANGELES

    DATE OF : NOVEMBER 25, 2021


    SHIPMENT

    5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
    num- numbers of criterion or other and date of
    ber packages (see notes quantity invoices
    overleaf)
    9 70 CT W 9503 840 PCE 489B/EXP.LBJ/11
    PO NO.: L-4788733 950300 357.5 KGM 21
    DISNEY ITEM : 400929814281 NOVEMBER 19,
    SUPPLIER STYLE NO.: 020Q221U012 2021
    FIG SET PLY IN PARK S21
    840 PCS / 70 CTNS

    10 12 CT W 9608 1,152 PCE 489B/EXP.LBJ/11


    PO NO.: L-4998497 960810 97.2 KGM 21
    DISNEY ITEM : 400944270758 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q222U010 2021
    PR222 TIANA FIG PEN
    1152 PCS / 12 CTNS

    11 16 CT W 9608 1,536 PCE 489B/EXP.LBJ/11


    PO NO.: L-4988434 960810 180.8 KGM 21
    DISNEY ITEM : 400943967307 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q222U011 2021
    PR222 RPNZL FIG PEN
    1536 PCS / 16 CTNS

    12 35 CT W 9608 2,520 PCE 489B/EXP.LBJ/11


    PO NO.: L-4233331 960810 198.1 KGM 21
    DISNEY ITEM : 400926363386 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q121U032 2021
    MNIAM121 PEN LUP
    2520 PCS / 35 CTNS

    11. Certification 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 and
    the declaration by the exporter is correct. statements are correct; that all the goods were
    INDONESIA
    produced in ..............................................................................
    ISSUING OFFICE IN KABUPATEN GRESIK (country)
    and that they comply with the origin requirements specified
    for those goods in the generalized system of preferences for
    goods exported to

    UNITED STATES OF AMERICA


    ..................................................................................................
    AGUS BUDIONO (importing country)
    GRESIK, JANUARY 24, 2022 GRESIK, JANUARY 24, 2022
    ..................................................................................................... ..................................................................................................
    Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory

    Page 3 / 5
    116897754159

    1. Goods consigned from ( exporter's business name, address, Reference No. 0000748/GRS/2022
    country)
    PT LANGGENG BUANA JAYA
    VETERAN MADYA NO.8
    INDONESIA GENERALIZED SYSTEM OF PREFERENCES
    CERTIFICATE OF ORIGIN
    2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)

    DISNEY THEME PARK MERCHANDISE FORM A


    DISTRIBUTION CENTER BUILDING 100
    Issued in INDONESIA
    1020 W. BALL ROAD ANAHEIM, CA 92803
    (country)
    UNITED STATES OF AMERICA

    See notes overleaf

    3. Means of transport and route (as far as known) 4. For official use

    SHIPPED BY : FOLEGANDROS 146N ISSUED RETROSPECTIVELY

    FROM : SURABAYA (PTT)

    TO : LOS ANGELES

    DATE OF : NOVEMBER 25, 2021


    SHIPMENT

    5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
    num- numbers of criterion or other and date of
    ber packages (see notes quantity invoices
    overleaf)
    13 52 CT W 9608 4,992 PCE 489B/EXP.LBJ/11
    PO NO.: L-4094405 960810 307.51 KGM 21
    DISNEY ITEM : 400916563383 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q220U089 2021
    TS20 FORKY FIG PEN
    4992 PCS / 52 CTNS

    14 49 CT W 9608 4,704 PCE 489B/EXP.LBJ/11


    PO NO.: L-4233323 960810 340.11 KGM 21
    DISNEY ITEM : 400932913384 NOVEMBER 19,
    SUPPLIER STYLE NO.: 050Q321U030 2021
    STAT321 PEN GROOT
    4704 PCS / 49 CTNS

    15 30 CT W 9503 720 PCE 489B/EXP.LBJ/11


    PO NO.: L-4964452 950300 93 KGM 21
    DISNEY ITEM : 400942915941 NOVEMBER 19,
    SUPPLIER STYLE NO.: 020Q122U029 2021
    TS PARACHUTE FIGS H22
    720 PCS / 30 CTNS

    16 375 CT W 9503 1,500 PCE 489B/EXP.LBJ/11


    PO NO.: L-4055365 950300 93 KGM 21
    DISNEY ITEM : 400916215251 NOVEMBER 19,
    SUPPLIER STYLE NO.: 020S320U020 2021
    ACC20 AVN CAMPUS FIG SET
    1500 PCS / 375 CTNS

    11. Certification 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 and
    the declaration by the exporter is correct. statements are correct; that all the goods were
    INDONESIA
    produced in ..............................................................................
    ISSUING OFFICE IN KABUPATEN GRESIK (country)
    and that they comply with the origin requirements specified
    for those goods in the generalized system of preferences for
    goods exported to

    UNITED STATES OF AMERICA


    ..................................................................................................
    AGUS BUDIONO (importing country)
    GRESIK, JANUARY 24, 2022 GRESIK, JANUARY 24, 2022
    ..................................................................................................... ..................................................................................................
    Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory

    Page 4 / 5
    116897754159

    1. Goods consigned from ( exporter's business name, address, Reference No. 0000748/GRS/2022
    country)
    PT LANGGENG BUANA JAYA
    VETERAN MADYA NO.8
    INDONESIA GENERALIZED SYSTEM OF PREFERENCES
    CERTIFICATE OF ORIGIN
    2. Goods consigned to (consignee's name, address, country) (Combined declaration and certificate)

    DISNEY THEME PARK MERCHANDISE FORM A


    DISTRIBUTION CENTER BUILDING 100
    Issued in INDONESIA
    1020 W. BALL ROAD ANAHEIM, CA 92803
    (country)
    UNITED STATES OF AMERICA

    See notes overleaf

    3. Means of transport and route (as far as known) 4. For official use

    SHIPPED BY : FOLEGANDROS 146N ISSUED RETROSPECTIVELY

    FROM : SURABAYA (PTT)

    TO : LOS ANGELES

    DATE OF : NOVEMBER 25, 2021


    SHIPMENT

    5. Item 6. Marks and 7. Number and kind of packages; description of goods 8. Origin 9. Gross weight 10. Number
    num- numbers of criterion or other and date of
    ber packages (see notes quantity invoices
    overleaf)
    17 122 CT W 9503 7,808 PCE 489B/EXP.LBJ/11
    PO NO.: L-4334861 950300 612.15 KGM 21
    DISNEY ITEM : 400930063579 NOVEMBER 19,
    SUPPLIER STYLE NO.: 020Q221U007 2021
    THE CHILD PULLBACK
    7808 PCS / 122 CTNS

    11. Certification 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 and
    the declaration by the exporter is correct. statements are correct; that all the goods were
    INDONESIA
    produced in ..............................................................................
    ISSUING OFFICE IN KABUPATEN GRESIK (country)
    and that they comply with the origin requirements specified
    for those goods in the generalized system of preferences for
    goods exported to

    UNITED STATES OF AMERICA


    ..................................................................................................
    AGUS BUDIONO (importing country)
    GRESIK, JANUARY 24, 2022 GRESIK, JANUARY 24, 2022
    ..................................................................................................... ..................................................................................................
    Place and date, signature and stamp of certifying authority Place and date, signature of authorized signatory

    Page 5 / 5

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