Faktur # Invoice Number JS 1006 Veirs Mill Road Rockville MD 20851 Phone 301 538 6887 , 202 904

5599 Email : josupreog@gmail.com www.cargousaindo.com www.man-intl.com

KONOSEMEN NON NEGOTIABLE BILL OF LADING

TRACKING NUMBER

Tanggal/Date / /

INSTRUKSI/INSTRUCTIONS HARAP DI ISI DENGAN HURUF BESAR DENGAN JELAS DAN DISERTAI FOTO COPY PASSPOR NO OF BOXES PLEASE FILL WITH BLOCK LETTER CLEARLY AND ATTACH COPY OF PASSPORT NAMA PENGIRIM DAN ALAMAT NAMA PENERIMA DAN ALAMAT INDONESIA SHIPPER NAME AND ADDRESS CONSIGNEE NAME INDONESIA ADDRESS NAMA : NAMA : ALAMAT : ALAMAT : PHONE : Email : Special Instructions : Phone Email : :

DAFTAR PERINCIAN BARANG PACKING LIST / SHIPPER DECLARATION

KETERANGAN Description BAJU KURUNG/DRESSES KAOS / T-SHIRT CELANA PANJANG/PANT CELANA PENDEK /SHORT PANT BAJU BAWAHAN / SKIRT JAKET /JACKETS KEMEJA /BLOUSES CELANA DALAM /PANTIES BEHA /BRASSIERS KERUDUNG /SCAFT BAJU BAYI / BABY CLOTHES TOPI /CAPS HANDUK / TOWEL KAOS KAKI /SOCKS SEPATU /SHOES JUMLAH Quantity KETERANGAN Description SEPRAY /BEDSHETTS SELIMUT /BLANKETS KORDEN /CURTAINS SABUNCUCI/DETERGENT PERKAKAS/KITCHEN UTENSILS ALAT KECANTIKAN/TOILETRIES MAKANAN /FOOD STUFF BUKU /BOOKS MAINAN /TOYS ALBUM FOTO/PHOTO SAJADAH /PRAYER MAT LAINNYA/OTHER JUMLAH Quantity REKENING BIAYA Account Title Charges Freight/Brokerage $ Insurance $ Pick Up/Handling $ Additional Taxes $ Crafting/boxing $ Documentation $ Other $ Sub Total $ Less Deposit $ Total Amount Due $ Delevery Agent : M.A.N International PTE Ltd 68,Tuas ,South Ave 2 , Singapore 637523 Tel:6741 4122, 67411606 Tomang, Jakarta, Indonesia Tel : + 62 85888905311

TIDAK UNTUK DIPERDAGANGKAN /NO COMMERCIAL VALUE

This is Certify that I am the consignee/shipper of the above Items.That The abovedetailed list is the true and corredt descri ption of the goods contained in this box/parcel being sent.That there are no undeclared,restricted,illigal orbanned items including firearms,ammunition,illigal drugs,combustible goods included in this shipment. SAYA DENGAN INI MENYATAKAN BAHWA TIDAK ADA BARANG- BARANG TERLARANGTERMASUK BAHAN MUDAH MELEDAK,SENJATA API MAUPUN OBAT-OBATAN TERLARANG

Shipper Signature/Date

Carrier Signature/Pickup Date

Carrier acknowledges receipt of package property described above is received in good order except as noted.