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ev. UJANG JAYA
EXPORT - IMPORT
Office: TI. Tangguk Bongkar IX No.90B Medan - Indonesia
Telp I Fax: (62-61) 8453929 - 8454070
Warehouse: n. Garuda 2 No.95 KIn.l3.8 Sei Semayang - Binjai - Medan
Email: u74ng@indosat.net.id
Issued By : SB&TBank
201 E. lamar Street
Americus, GA 31709
Attn: Sam Hunter
Phone: (229) 924-0305
Fax: (229) 928-3747
For account Of Messrs : Cooperative Coffees Inc.
302 W. lamar St. Suite E.
Americus, GA 31709 USA
Tel. +1-229-924-3035
Fax. +1-229-924-6250
Shipment From : Belawan -Indonesia to New York, NY
PerS.SI M.V : Sinar Biak V.239 Dated. April 10, 2010
. V esse
Connectlng Presl·dentAd ams V 0214W
Marks & Number Description Of Goods Quantity Price trons Total Value
MlTons USD USD
015/1607/19 1 X 20 ft CONTAINER
CV. UJANG JAYA FLO-ID 6117
CERTIFIED ORGANIC
11271807930
NEIT 60 KGS
1/300
HJCU2150189/ S / HB453134
lJSI
SU~N/~V~E~RSAl SHIPPING, INC.
BILL OF LADING
CTPAT NO. 72545308 OTI LICENSE NO. 17577NF
SHIPPER/EXPORTER: DOCUMENT NO. I
BILL OF LADING NO
BLWNYC041126
CV.UJANGJAYA DOMESTIC ROUTING/EXPORT INSTRUCTION
EXPORT REFERENCES:
cONSIe:'C50PERATIVE COFFEES, INC MBL NO : HJSCBLW100651500
302 W.LAMAR STREET SUITE E. FOR CARGO DEUVERY PlEASE CONTACT:
POMONA, CA 91766
"I0TIFY PARTY:
CERTIFIED ORGANIC
NETT 60 KG
FIF:81 OR~( UNAL
~~.,,--_,~~
1/300
TOTAL NUMBER OF CONTAINERS OR ONE UNIT TWENTY CONTAINER ONLY
PACKAGED (IN WORLD)
RECEIVED by the Carrier the Goods as specified above in apparent good order and condition FREIGHT CHARGES PREPAID COLLECT
unless otherwise stated, to be transported to such place as agreed, authorized or permitted hereon
and subject to all the terms and cond~ions appearing on the front and reverse of this Bill of Lading
to which the merchant agrees by accepting this Bill of Lading, any local privileges and customs
notwithstanding.
The particulars, given above as stated by the shipper and the weight, measure, quantity condition,
FREIGHT COLLECT
contents and value of the Goods are unknown to the carrier.
In WITNESS whereof one (1) original Bill of Lading has been signed if not otherwise stated above
the same being accomplished the other if any to be void if required by the Carrier one (1) Original
Bill of Lading must be surrendered duly endorsed in exchange for the goods of delivery order.
011
Place and date of issue --r==.,.."¢f)=~;111!!:::;;;===,-
signed on behaif of the Carrier:
TOTAL CHARGES
CERTIFICATE FOR IMPORT INTO NON EUROPEAN COMMUNITY COUNTRIES OF
PRODUCTS OBTAINED ACCORDING TO ORGANIC PRODUCTION METHODS
1. Body Issuing the CertIficate (Certifying Body) 2. Reference Number
NCO 320
STIRLING SOUTH AUSTRALIA 5152
3. Exporter of the product (Name & Address) 4. Control Body (Name & Address)"
INDONESIA
,IL. GARUDA 2 NO. 95 KM. 13,8 SEI SEMAYANG 6a. Port of discharge
10. Marks & Numbers, Container No(s),Number & Kind Trade Name of the Product 11. Gross Weight (kg)
015/1607/19 CV. UJANG JAVA FLo-lD 6117 CERTIFIED 100"10 ORGANIC 18,300
HJCU2150189/ S / HB453134
300 BAGS
Box 4: Control body for monitoring compliance with the rules on oriPllic production methods
Box 5: The ftrm which carried out the last operation (processing, packaging, labelling) on the batch
Box 9: The address of the firm where the batch wll be delivered. if different from the address in box 7
Box 13: e.g. volume in lilres in case ofliquids. to be given, where appropriate, in supplement to the declarations in boxes I I and 12