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SHIPPER'S DECLARATION FOR DANGEROUS GOODS

Shipper
PT. JVD Indonesia (DGEX Indonesia), Soewarna Integrated Air Waybill No. 180-9919 7696/ NTI-NAE02614
Business Park, Warehouse Area, Block B, Lot 7-8,Unit E-10
Tangerang 19110 Indonesia, Tel : (+6221) 5591 1067, For: Page 1 of 1 Pages
PT.FREE TRADE LOGISTICS, DUTA GARDEN SQUARE BLOK A.9
JL.HUSEIN SASTRANEGARA Shipper's Reference Number 5652-070918-OFA112
TANGERANG 1512 - INDONESIA (optional)

Consignee
JAPAN BROADCASTING CORPORATION (NHK)
2-2-1 JINNAN, SHIBUYA-KU, TOKYO
150-8001, JAPAN

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 : Narita, Japan 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 3480 Lithium ion batteries 9 6 Fibreboard Boxes x 6 Kg 965 1B
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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
SoC Is Not More Than 30%

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, September 7, 2018
requirements have been met.
Signature
(see warning above)

Copyright © 2018 DGEX Indonesia