KSO SUCOFINDO - SURVEYOR INDONESIA

VERIFICATION REQUEST

Refer to the terms and conditions of "KETENTUAN VERIFIKASI ATAU PENELUSURAN TEKNIS IMPOR (VPTI) Tekstil dan Produk Tekstil No. 002/KSO-VPTI/IV/2003" that we have
already read and understood, herewith we are submitting the VR as follows :

Commodity : Tekstil dan Produk Tekstil

VR. Submission No. : 1909200284
VR. Submission Date. : 20/09/2019 13:24:05

IMPORTER EXPORTER
Name : PT. KOTA JATI FURINDO Name : GLEN RAVEN ASIA
Contact : RONI WIBOWO Contact : LYNN GAN, MANDY YANG
Address : JL.RAYA BANGSRI KM.6,5, SUWAWAL BARAT, Address : NO. 8 MEI YI STREET EAST SU HONG ROAD,
MLONGGO SIP
City : KAB. JEPARA, JAWA TENGAH 59452 City : SUZHOU, JIANGSU PROVINCE
Phone : 0291-596310 Country : CN
Fax : 0291-596311 Phone : 86-512-67638126
Email : export@kotajati.com;
Fax :
admexport@kotajati.com
NPWP : 01.864.445.0-511.000 Email : lgan@glenraven.com;jyang@glenraven.com
Status : API-P
API/NIB No. : 112000305-P

SUPPLIER
Supplier Name : GLEN RAVEN CUSTOM FABRICS, LLC
Contact : MARTIN, LAURA
Address : 1831 NORTH PARK AVENUE, GLEN RAVEN, NC 27217-1100
Country :
Telephone : (001)336-227-6211
Mobile Phone :
Fax : (001)336-229-4039
Email : LMartin@glenraven.com

Mode of Transport : SEA (LCL) Total Value : 15,568.20

Port Of Loading : SUZHOU Currency : USD
Port Of Discharge : TANJUNG EMAS Incoterm : EXW
Date Of Shipment : 30/09/2019 Total Net Weight : 1,900.000 KGM
Date Of Discharge : 14/10/2019 Partial Shipment : Allowed

Pref.
No. HS Code Goods Description Origin Quantity License No.
Facility

1. 55122900 FF 40432 FIBER COMPOSITION/CONTENT : 100% CHINA 1,700.780 MTR ACFTA 04.PI-67.19.0348
ACRYLIC YARN TYPE (STAPLE OR FILAMENT) : 100%
STAPLE , IF STAPLE (CARDED OR COMBED) : 100%
CARDED , IF FILAMENT (HIGH TENACITY, TEXTURED
OR NON TEXTURED) : N/A, KIND OF WEAVE (PLAIN,
TWILL, SATIN OR OTHERS) : PL
SPPT SNI:

Order/Invoice No. : 0000103407

Import License No. : 04.PI-67.19.0348
Remarks :

I herewith notify:
We understand and agree to pay 50% of inspection fee in advance when submitting Verification Request (transfer payment is attached) and will be completed the payment before or when
collected the LS or deposit payment

Name : RONI WIBOWO

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