AQUACULTURE SIMP DATA

IMPORTER: U.S. CONSIGNEE: IFTP Permit Name & Number : BILL OF LADING #DJA1236822
H & N Group, Inc H & N Group, Inc IFTP00046707 Container # CGMU 5116439

HARVESTING COUNTRY: INDONESIA WILD CAUGHT OR SCIENTIFIC SPECIES CODE: GEOGRAPHIC LOCATION :
FARM RAISED: FARM RAISED PNV Desa Durian, Kecamatan Padang Cermin
Kabupaten Pesawaran , Provinsi Lampung

Fishing Gear Type: Wild Caught Only Processing Description:

Frozen Raw Shrimp Frozen Raw Ez-Peel White Shrimp "GREAT CATCH"
Brand Size 13/15

LINE 1-Product (SHELL ON REQUIRES Aquaculture Facility: Harvesting date: Weight in Kilograms:
SPLIT OUT DATA FOR EACH TARIFF PT. Maju Tambak Sumur 1) 05/05/2024 1) 16377.37 4) 4)
SIZE): Desa Durian, Kecamatan Padang Cermin Kabupaten Pesawaran , Provinsi 2) 06/05/2024 2) 16096.05 5) 5)
Lampung Agatha 3) 3) 6) 6)
Ariany ph. 0254-8480797 [email protected]

LINE 1 -Continued Additional Aquaculture Facility Harvesting date: Weight in Kilograms:

(Second Farm if applicable) 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 1 -Continued Additional Aquaculture Facility Harvesting date: Weight in Kilograms:

(Third farm if applicable) 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Second Product (Shell on by size Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
group) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Continued (Second farm if Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
applicable) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Continued (Third farm if Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
applicable) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)
H&N GROUP - SIMP - TRANSSHIPMENT CERTIFICATE FOR TRACEABILITY

FROM TO
UNIQUE
STORAGE LOCATION OF COLD STORAGE UNLOADED
WILD/FA CATCH/HARVES LOADING OR POINT OF CONTACT POINT OF CONTACT COLD STORAGE COLD STORAGE UNLOADED TO POINT OF CONTACT POINT OF CONTACT COLD STORAGE PRODUCT SCIENTIFIC PRODUCT TRANSSHIPPED PRODUCTION # OF TYPE OF
# LOADING/UNLOADING OR PORT FROM (COMPANY NAME & POINT OF CONTACT POINT OF CONTACT PRODUCT MARKET NAME LBS/KG LOT # TRANSSHIPPED PRODUCT FORM
RM T DOCUMENT UNLOADING EMAIL PHONE REGISTRATION # (COMPANY NAME & ADDRESS) EMAIL PHONE REGISTRATION # NAME AFSIS# WEIGHT DATE PACKAGES PACKAGING
NAME ADDRESS)
ID#
JL. SUMATERA NO.13 KAWASAN
INDUSTRI MEDAN - MEDAN - E3 24127 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
1 FARM MS.06 06/05/2024 PT. BAHARI MAKMUR SEJATI Agatha Ariany [email protected] 6261 685 8746 10372119218 VIMC DIAMOND V. 24VD006W CMA CGM LINE [email protected] 6261 685 8746 DJA1236822 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 18160 Lbs 05/06/2024 908
SUMATERA UTARA 20242 - HN427 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
INDONESIA
JL. SUMATERA NO.13 KAWASAN
INDUSTRI MEDAN - MEDAN - E3 24128 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
2 FARM MS.07 06/05/2024 PT. BAHARI MAKMUR SEJATI Agatha Ariany [email protected] 6261 685 8746 10372119218 VIMC DIAMOND V. 24VD006W CMA CGM LINE [email protected] 6261 685 8746 DJA1236822 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 17840 Lbs 05/07/2024 892
SUMATERA UTARA 20242 - HN427 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
INDONESIA
H&N GROUP - SIMP - PROCESSING CERTIFICATE FOR TRACEABILITY

UNIQUE RECEIVED
WILD/FA COMPANY RAW MATERIAL POINT OF CONTACT POINT OF CONTACT PROCESSOR FDA PRODUCT SCIENTIFIC PRODUCT RECEIVED RECEIVED LOT PROCESSED PRODUCTION # OF TYPE OF
# CATCH/HARVEST PROCESSOR COMPANY NAME PROCESSOR POINT OF CONTACT PROCESSOR ADDRESS PRODUCT MARKET NAME LBS/KG PRODUCT LBS/KG FINISHED LOT # FINISHED FORM
RM RECEIVED FROM NUMBER EMAIL REGISTRATION # NAME AFSIS# WEIGHT ID# WEIGHT DATE PACKAGES PACKAGING
DOCUMENT ID# FORM

JL. SUMATERA NO.13 KAWASAN

E3 24127 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
1 FARM MS.06 PT. MAJU TAMBAK SUMUR PT. BAHARI MAKMUR SEJATI Agatha Ariany 6261 685 8746 [email protected] INDUSTRI MEDAN - MEDAN - 10372119218 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 16377.37 Kg MS/05 HEAD ON 7906.99 Kg 05/06/2024 908
HN427 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
SUMATERA UTARA 20242 - INDONESIA

JL. SUMATERA NO.13 KAWASAN

E3 24128 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
2 FARM MS.07 PT. MAJU TAMBAK SUMUR PT. BAHARI MAKMUR SEJATI Agatha Ariany 6261 685 8746 [email protected] INDUSTRI MEDAN - MEDAN - 10372119218 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 16096.05 Kg MS/05 HEAD ON 7771.17 Kg 05/07/2024 892
HN427 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
SUMATERA UTARA 20242 - INDONESIA
H&N GROUP - SIMP - TRANSSHIPMENT CERTIFICATE FOR TRACEABILITY

FROM TO
UNIQUE
STORAGE LOCATION OF COLD STORAGE UNLOADED
WILD/FA CATCH/HARVES LOADING OR POINT OF CONTACT POINT OF CONTACT COLD STORAGE COLD STORAGE UNLOADED TO POINT OF CONTACT POINT OF CONTACT COLD STORAGE PRODUCT SCIENTIFIC PRODUCT TRANSSHIPPED PRODUCTION # OF TYPE OF
# LOADING/UNLOADING OR PORT FROM (COMPANY NAME & POINT OF CONTACT POINT OF CONTACT PRODUCT MARKET NAME LBS/KG LOT # TRANSSHIPPED PRODUCT FORM
RM T DOCUMENT UNLOADING EMAIL PHONE REGISTRATION # (COMPANY NAME & ADDRESS) EMAIL PHONE REGISTRATION # NAME AFSIS# WEIGHT DATE PACKAGES PACKAGING
NAME ADDRESS)
ID#
JL. SUMATERA NO.13 KAWASAN
INDUSTRI MEDAN - MEDAN - E3 24125 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
1 FARM MS.04 06/05/2024 PT. BAHARI MAKMUR SEJATI Agatha Ariany [email protected] 6261 685 8746 10372119218 VIMC DIAMOND V. 24VD006W CMA CGM LINE [email protected] 6261 685 8746 DJA1236821 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 18060 Lbs 05/04/2024 903
SUMATERA UTARA 20242 - HN426 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
INDONESIA
JL. SUMATERA NO.13 KAWASAN
INDUSTRI MEDAN - MEDAN - E3 24126 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
2 FARM MS.05 06/05/2024 PT. BAHARI MAKMUR SEJATI Agatha Ariany [email protected] 6261 685 8746 10372119218 VIMC DIAMOND V. 24VD006W CMA CGM LINE [email protected] 6261 685 8746 DJA1236821 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 17940 Lbs 05/05/2024 897
SUMATERA UTARA 20242 - HN426 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
INDONESIA
H&N GROUP - SIMP - PROCESSING CERTIFICATE FOR TRACEABILITY

UNIQUE RECEIVED
WILD/FA COMPANY RAW MATERIAL POINT OF CONTACT POINT OF CONTACT PROCESSOR FDA PRODUCT SCIENTIFIC PRODUCT RECEIVED RECEIVED LOT PROCESSED PRODUCTION # OF TYPE OF
# CATCH/HARVEST PROCESSOR COMPANY NAME PROCESSOR POINT OF CONTACT PROCESSOR ADDRESS PRODUCT MARKET NAME LBS/KG PRODUCT LBS/KG FINISHED LOT # FINISHED FORM
RM RECEIVED FROM NUMBER EMAIL REGISTRATION # NAME AFSIS# WEIGHT ID# WEIGHT DATE PACKAGES PACKAGING
DOCUMENT ID# FORM

JL. SUMATERA NO.13 KAWASAN

E3 24125 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
1 FARM MS.04 PT. MAJU TAMBAK SUMUR PT. BAHARI MAKMUR SEJATI Agatha Ariany 6261 685 8746 [email protected] INDUSTRI MEDAN - MEDAN - 10372119218 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 16266.74 Kg MS/05 HEAD ON 7853.58 Kg 05/04/2024 903
HN426 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
SUMATERA UTARA 20242 - INDONESIA

JL. SUMATERA NO.13 KAWASAN

E3 24126 FROZEN RAW SHRIMP FROZEN RAW EZ- MASTER
2 FARM MS.05 PT. MAJU TAMBAK SUMUR PT. BAHARI MAKMUR SEJATI Agatha Ariany 6261 685 8746 [email protected] INDUSTRI MEDAN - MEDAN - 10372119218 PENAEUS VANNAMEI WHITE LEG SHRIMP PNV 16175.42 Kg MS/05 HEAD ON 7809.49 Kg 05/05/2024 897
HN426 005 PEEL WHITE SHRIMP SIZE 13/15 CASE
SUMATERA UTARA 20242 - INDONESIA
 AQUACULTURE SIMP DATA
IMPORTER: U.S. CONSIGNEE: IFTP Permit Name & Number : BILL OF LADING #DJA1236821
H & N Group, Inc H & N Group, Inc IFTP00046707 Container # TTNU 8516630

HARVESTING COUNTRY: INDONESIA WILD CAUGHT OR SCIENTIFIC SPECIES CODE: GEOGRAPHIC LOCATION :
FARM RAISED: FARM RAISED PNV Desa Durian, Kecamatan Padang Cermin
Kabupaten Pesawaran , Provinsi Lampung

Fishing Gear Type: Wild Caught Only Processing Description: Desa Bakauheni, Kecamatan Bakauheni
Frozen Raw Shrimp Frozen Raw Ez-Peel White Shrimp "GREAT CATCH" Kabupaten Lampung Selatan, Provinsi
Brand Size 13/15 Lampung

LINE 1-Product (SHELL ON REQUIRES Aquaculture Facility: Harvesting date: Weight in Kilograms:
SPLIT OUT DATA FOR EACH TARIFF PT. Maju Tambak Sumur 1) 03/05/2024 1) 16266.74 4) 4)
SIZE): Desa Durian, Kecamatan Padang Cermin Kabupaten Pesawaran , Provinsi 2) 2) 5) 5)
Lampung Agatha 3) 3) 6) 6)
Ariany ph. 0254-8480797 [email protected]

LINE 1 -Continued Aquaculture Facility: Harvesting date: Weight in Kilograms:

(Second Farm if applicable) PT. Maju Tambak Sumur 1) 04/05/2024 1) 16175.42 4) 4)
Desa Bakauheni, Kecamatan Bakauheni Kabupaten Lampung Selatan, 2) 2) 5) 5)
Provinsi Lampung Agatha 3) 3) 6) 6)
Ariany ph. 0254-8480797 [email protected]

LINE 1 -Continued Additional Aquaculture Facility Harvesting date: Weight in Kilograms:

(Third farm if applicable) 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Second Product (Shell on by size Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
group) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Continued (Second farm if Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
applicable) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)

LINE 2 Continued (Third farm if Additional Aquaculture Facility Harvesting date: Weight in Kilograms:
applicable) Including Name, Address, Contact name, Phone number, or Email: 1) 1) 4) 4)
2) 2) 5) 5)
3) 3) 6) 6)
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

FROZEN RAW SHRIMP FROZEN RAW PEELED PT. Maju Tambak Sumur / Desa Durian,
PNV DEVEINED TAIL ON WHITE SHRIMP " SMART & FINAL 16/20 INDONESIA Kecamatan Padang Cermin, Kabupaten Agatha Ariany [email protected] 30-Apr-2024 30-Apr-2026 29-Apr-2024 16414.77
FIRST STREET " BRAND Pesawaran, Provinsi Lampung

FROZEN RAW SHRIMP FROZEN RAW PEELED PT. Maju Tambak Sumur / Desa Bakauheni,
PNV DEVEINED TAIL ON WHITE SHRIMP " SMART & FINAL 16/20 INDONESIA Kecamatan Bakauheni Kabupaten Lampung Agatha Ariany [email protected] 02-May-2024 02-May-2026 01-May-2024 16137.03
FIRST STREET " BRAND Selatan, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Desa Bakauheni,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 21/30 INDONESIA Kecamatan Bakauheni Kabupaten Lampung Agatha Ariany [email protected] 07-May-2024 07-May-2026 06-May-2024 16561.03
SHRIMP " MASTER CATCH " BRAND
Selatan, Provinsi Lampung

PT. Maju Tambak Sumur / Dusun Ketang, Desa

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 21/30 INDONESIA Way Urang, Kecamatan Kalianda Kabupaten Agatha Ariany [email protected] 08-May-2024 08-May-2026 07-May-2024 16094.13
SHRIMP " MASTER CATCH " BRAND
Lampung Selatan, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Desa Durian,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 31/40 INDONESIA Kecamatan Padang Cermin, Kabupaten Agatha Ariany [email protected] 04-May-2024 04-May-2026 03-May-2024 16485.30
SHRIMP " STATER BROS " BRAND
Pesawaran, Provinsi Lampung

PT. Maju Tambak Sumur / Desa Durian,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 31/40 INDONESIA Kecamatan Padang Cermin, Kabupaten Agatha Ariany [email protected] 05-May-2024 05-May-2026 04-May-2024 16613.72
SHRIMP " STATER BROS " BRAND
Pesawaran, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Desa Bakauheni,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 16/20 INDONESIA Kecamatan Bakauheni Kabupaten Lampung Agatha Ariany [email protected] 26-Apr-2024 26-Apr-2026 25-Apr-2024 16387.08
SHRIMP " MASTER CATCH " BRAND
Selatan, Provinsi Lampung

PT. Maju Tambak Sumur / Desa Bakauheni,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 16/20 INDONESIA Kecamatan Bakauheni Kabupaten Lampung Agatha Ariany [email protected] 27-Apr-2024 27-Apr-2026 26-Apr-2024 16468.90
SHRIMP " MASTER CATCH " BRAND
Selatan, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Dusun Ketang, Desa

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 13/15 INDONESIA Way Urang, Kecamatan Kalianda Kabupaten Agatha Ariany [email protected] 03-May-2024 03-May-2026 02-May-2024 16092.06
SHRIMP " GREAT AMERICAN " BRAND
Lampung Selatan, Provinsi Lampung

PT. Maju Tambak Sumur / Dusun Ketang, Desa

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 13/15 INDONESIA Way Urang, Kecamatan Kalianda Kabupaten Agatha Ariany [email protected] 04-May-2024 04-May-2026 03-May-2024 16343.70
SHRIMP " GREAT AMERICAN " BRAND
Lampung Selatan, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Desa Durian,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 16/20 INDONESIA Kecamatan Padang Cermin, Kabupaten Agatha Ariany [email protected] 28-Apr-2024 28-Apr-2026 27-Apr-2024 15922.97
SHRIMP " MASTER CATCH " BRAND
Pesawaran, Provinsi Lampung

PT. Maju Tambak Sumur / Desa Durian,

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 16/20 INDONESIA Kecamatan Padang Cermin, Kabupaten Agatha Ariany [email protected] 29-Apr-2024 29-Apr-2026 28-Apr-2024 16299.19
SHRIMP " MASTER CATCH " BRAND
Pesawaran, Provinsi Lampung
 2018 NMFS Seafood Import Monitoring Program Requirements (This form is intended for customs broker’s
entry purposes only, it is the importer’s responsibility to comply with full record keeping requirements as they are a separate requirement from NOAA)

IFT Permit No. : IFTP00046970

Farm Raised Shrimp

Aquaculture Farm Contact PH# and email
1. Species (3-Alpha): Product Name Size Country Contact Person Production Date Sell by Date Harvest Date Harvest Weight
(complete name and address) address

PT. Maju Tambak Sumur / Dusun Ketang, Desa

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 26/30 INDONESIA Way Urang, Kecamatan Kalianda Kabupaten Agatha Ariany [email protected] 29-Apr-2024 29-Apr-2026 28-Apr-2024 16425.65
SHRIMP " GREAT AMERICAN " BRAND
Lampung Selatan, Provinsi Lampung

PT. Maju Tambak Sumur / Dusun Ketang, Desa

FROZEN RAW SHRIMP FROZEN RAW EZ-PEEL WHITE
PNV 26/30 INDONESIA Way Urang, Kecamatan Kalianda Kabupaten Agatha Ariany [email protected] 30-Apr-2024 30-Apr-2026 29-Apr-2024 16340.75
SHRIMP " GREAT AMERICAN " BRAND
Lampung Selatan, Provinsi Lampung