SELLER
IMPORTER
|
| Import Reference No. |
LPS No. |
PT. SURVEYOR INDONESIA, Jakarta
LAPORAN PEMERIKSAAN SURVEYOR
(Surveyor's (asspection to the Import requirements of
the Republic of Indonesia
|
| B/L AWB. No. |
B/L AWB. Date |
Voyage No. : |
| . |
Port of Loading : |
| Port of Discharge Code |
Port of Transhipmen : |
|
Invoice No. & Date
|
. |
| Sales Terms |
Carrency |
Invoice Total (A) |
| Total Nett Weight (Kg) |
Total Gross Weight (Kg) |
|
Packing & Marks/Container Nos.
|
No.
|
Goods description
|
No.
TBK
BKT
PPN
PPn BM
PPh22
TOTAL
|
UNTUK BANK DEVISA (sebagai keperluan referens)
| R.S. |
|
|
JUMLAH NILAI |
|
|
TBK |
|
|
PBK |
|
|
BKT |
|
|
PPN |
|
PPn BM |
|
PPh22 |
|
|
UNTUK DEPARTEMEN KEUANGAN
|
|
|
|
FOB |
|
|
|
|
|
FREIGHT |
|
|
|
|
|
INSURANCE |
|
|
|
|
TOTAL |
|
|
|
|
|
Skep Fasilitas
|
Place and date of issue |
| Issued by |
|
|
Not valid without an authorised signature
it is not the purpose of this surveyor's inspection to release sellers
from their legal and contractual obligations
|