SHIPPER'S DECLARATION FOR DANGEROUS GOODS

Shipper
PT. JVD Indonesia (DGEX Indonesia), Soewarna Integrated Air Waybill No. 618- 5161 2422
Business Park, Warehouse Area, Blok B, Lot 7-8, Unit E-10
Tangerang 19110 Indonesia, Tel: (+6221) 5591 1067, FOR: Page 1 of 1 Pages
PT. Mane Indonesia, Cikarang Industrial Estate
Jl. Jababeka XVI Blok V66 - Cikarang - Bekasi Shipper's Reference Number 5237-180518-OFA112
17530 - Indonesia, Tel : (62) 21 893 7640 (optional)

Consignee
V. Mane Fils (Thailand) Co. Ltd.
284 Ladkrabang Industrial Estate, General Zone Phase III
Moo 4, Chalongkrung Road, Lamplathiew, Ladkrabang
Bangkok 10520, Thailand
Phone : (662) 326 0100 Fax : (662) 326 0155

Two completed and signed copies of this Declaration must WARNING

be handed to the operator.
TRANSPORT DETAILS Failure to comply in all respects with the applicable
This shipment is within the Airport of Departure: Dangerous Goods Regulations may be in breach
limitations prescribed for: of the applicable law, subject to legal penalties.
(delete non-applicable)
PASSENGER CARGO Soekarno - Hatta, Indonesia
AND CARGO AIRCRAFT
AIRCRAFT ONLY

Airport of Destination : Bangkok, Thailand Shipment type : (delete non-applicable)

NON-RADIOACTIVE RADIOACTIVE

NATURE AND QUANTITY OF DANGEROUS GOODS

Dangerous Goods Identification
UN Class Quantity and Packing
Pack- Authorization
Or Or Division type of packing Inst.
Proper Shipping Name ing
ID (Subsidiary
Group
No. Risk)
UN 1197 Extracts, flavouring, liquid 3 III 1 Fibreboard Box x 34.4 L 355
1 Fibreboard Box x 25.8 L
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
—————————————————————————————————————————————————————————————
Additional Handling Information

24 Hour Emergency Contact Number: +62 823 7807 4550, +62 812 1047 2002, Contact Person : Arif Tawil
IATA Certificate No: 278100, SKP No: 0010669/DG.A2/DKP/XI/2016, Comp Certificate: 1168/DG-PTC/XII/16

I hereby declare that the contents of this consignment are fully and Name/Title of Signatory
accurately described above by the proper shipping name, and are classified,
packaged, marked and labelled/placarded, and are in all respects in proper Arif Tawil / Operation Specialist
condition for transport according to applicable International and national Place and Date
governmental regulations. I declare that all of the applicable air transport
Jakarta, May 18, 2018
requirements have been met.
Signature
(see warning above)

Copyright © 2018 DGEX Indonesia