DOCX Ministry of International Trade and Industry

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ANNEX II REPORT ON THE TOTAL NUMBER OF ORIGIN DECLARATION

PERIOD : 1 JANUARY UNTIL 31 MARCH 2021

EXPORTER : ABCD SDN. BHD.

CERTIFIED EXPORTER AUTHORIZATION CODE : MY-SC2020J001

BIL. INVOICE NO. IMPORTER AHTN (10 Digit)

NAME OF THE PRODUCT ORIGIN CRITERION

COUNTRY OF ORIGIN

FOB VALUE

1. A 987654321 Serindit Pte Ltd. 7101.10.00.00 Natural pearls WO MALAYSIA 1,000,500.00

2 A 987654322 Tropical Fruit

Ptd.Ltd. 0807.11.00.00 Watermelons WO MALAYSIA 1,000,500.00

3 A 987654323 Mai Pen Rai

Food Co.Ltd. 1006.30.30.00 Glutinous rice (Pulot) WO THAILAND 1,000,500.00 4 A 987654324 Poktek Yamtom

Electric Co.Ltd

8548.10.21.10 Primary cell and batteries WO INDONESIA 1,000,500.00

Total A

4,002,000.00

5. B 987654321 Maju Jaya

Ptd.Ltd. 1514.19.10 90 Refining Crude oil SP MALAYSIA 2,000,500.00

6. B 987654322 Flavour Food Co.Ltd.

1517.90.20.00 Margarine SP MALAYSIA 2,000,500.00

7. B 987654323 Medical Treat

Co.Ltd 9019.20.00.00 Ozone therapy SP VIETNAM 2,000,500.00

8. B 987654324 Dagang Kapas

Ptd.Ltd. 5007.20.00.00 Woven fabrics of silk SP MALAYSIA 2,000,500.00

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BIL. INVOICE NO. IMPORTER AHTN (10 Digit)

NAME OF THE PRODUCT ORIGIN CRITERION

COUNTRY OF ORIGIN

FOB VALUE

Total B

8,002,000.00

9. C 987654321 Public Thailand

Wheel Co.Ltd 8714.92.10.12 Wheel rims and spokes RVC 72.65% SINGAPORE 3,000,500.00 10. C 987654322 Thailand Vehicle

Co.Ltd 8708.40.90.90 Gear boxes RVC 40.85% MALAYSIA 3,000,500.00

11. C 987654323 Auto Surasak

Co.Ltd 8421.23.91.00 Oil-filters RVC 99.81% MALAYSIA 3,000,500.00

Total C

9,001,500.00

TOTAL INVOICE DECLARATION (A+B+C)

21,005,500.00

Notes:

1. Please refer to your Cost Analysis (CA) approval for AHTN Code and Origin Criterion. Exporter shall apply for new CA if the CA is expiring/has already expired/there are changes to the costing or suppliers details.

2.

Please provide report on the total number of Origin Declaration to MITI on quarterly basis (before 5th of each month) and email to the AWSC Secretariat at atiga.selfcert@miti.gov.my.

3.

For more information or enquiries, kindly refer to http://web.awsc.asean.org/ or contact the AWSC Secretariat at 03-6208 4772 or email to atiga.selfcert@miti.gov.my.