The Republic of Indonesia Ministry of Marine Affairs and Fisheries Fish Quarantine and Inspection Agency

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THE REPUBLIC OF INDONESIA

MINISTRY OF MARINE AFFAIRS AND


FISHERIES
FISH QUARANTINE AND INSPECTION AGENCY
HEALTH CERTIFICATE FOR FISH AND FISHERY PRODUCTS
REF. Number :

K1-D/BKIPM/X/12/16/2021

NO Common Name Scientific Name Quantity Unit


1 Koi Fish Cyprinus Carpio 6 PCS

TOTAL : 6 PCS

1.Consignor 2. Competent authority


PT JBG TRANSHIPPING SERVICE Authority of the Department of Agriculture,food
VII Blok AG no19,RT.8/RW.10,Sunter Jaya,Tanjung security and fisheries of the city of Jakarta
Priok,North Jakarta City,Jakarta 14360
Tel&Fax : +62 81297971227
3.Consignee
WIRATTANA TALUMSIIN
99/3 Centro Ramintra-Chatuchot Or Ngoen
Saimai 10220
Tel&Fax : 0929294955 & 0657891542

4. Producing establishment / farm Establishment ID Number


: Name : Samurai Koi Farm 50551

5. Country and region of origin: 6. Source :


INDONESIAN
Farm-raised wild-caught

7. Place of shipment : 8.Means of transport :


NORTH JAKARTA By Air freight By sea freight

9. Description of commodity : 10.Temperature of the commodity


Export of ornamental koi fish to Thailand
Ambient(live) frozen chilled

11. Commodities intended for uses as : 12. Total number of package


Human consumption
Culture/breeding(broodstock,eggs,gametes) 3 BOX
Ornamental
Research &Investigation
Aquatic animal feed/baits
*(information on batch see attachment if insufficient)
Non edible(fish,skin,shell,bones,etc)

13.Type of packaging : 14.Total quantity(kg)


BOX 18.50 KG
15. Identification of container seal number : 16.Port entry :
a. Seal number : 2090596 SUVARNABHUMI INTERNATIONAL AIRPORT
b. Container Number : (not required for Airfreight)

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