BALAl BE5AR /ffiNJELIDIKAN PERTANIAN, 
FALAJ PENJELID1KAN HAMA TUMBUH2 - AN, 
DINAS K A I? ANT IN A TUMBUH2-AN. 
F INDONESIA 
F AGRICULTURE 
Jfc 13389 
GENERAL AGRICULTURAL RESEARCH STATION, 
INSTITUTE FOR PLANT DISEASES AND PESTS, 
PLANT QUARANTINE SERVICE. 
mm 
PHYTOSANITARY CERTIFICATE 
SURAT KESEHATAN BAHAN TUMBUH 2 -AN 
This is to certify that the plants, parts of plants or plant products described below or representative samples of t hem were thoroughly 
Bersama ini diterangkan bahwa tumbuh 2 -an, bagian dari tumbuh 3 an atau bahan tumbuh 2 -an jang disebut dibawah ini atau tjontoh 2 jang 
examinated o n SepiteititeX.- 12, - -19&3 
mewakili party tersebnt telah diperiksa dengan teliti pada tgl. 
by an authorized officer of Plant Quarantine Service in 3 g» v -0^* 
oleh sebagai ahli pemeriksa Dinas Karantina Tumbuh 2 -an 
and were found to the best of his knowledge to be substantially free from injurious diseases and pests and the consignment is believed 
dan menurut hasil pemeriksaannja, telah dianggap bebas dari penjakit maupun hama tumbuh 2 -an dan bahan kiriman tersebut dianggap telah 
to conform with the current phytosanitary regulation of the importing country both as stated in the additional declaration her eon and 
raemenuhi sjarat 2 kesehatan tanaman jang dikehendaki oleh negeri jang di tudju sebagaimana dinjatakan pada kedua keterangan berikut 
otherwise. 
| dan keterangan lain B -nja. 
DESCRIPTION OF THE CONSIGNMENT 
KETERANGAN BAHAN KIRIMAN 
Name 
.nd address .f Export., LeCifea 
Nama dan alamat Eksportir 
Name and address of Consignee ... T}u # .. .to II - - 
Nama dan alamat Penerima 
Number and description of packages 
- c lr/0"bfcp;s 
• As • p.fidre s-setv • 
Djumlah dan keterangan koli 
Distinguishing marks 
Tanda-tanda istimewa 
Origin (if required by importing country) • Qr * >‘Q 
Daerah asal (bila diperlukan negeri tudjuan) 
Means of conveyance P It* MQ Point of entry 
Diangkut dengan Pelabuhan pemasukan 
| Quantity and name of produce g . 
*Djumlah dan nama bahan tanaman 
Botanical name (if required by importing 
Nama botani (bila diperlukan oleh negeri tudjuan) 
2plfctt ts ■ ■ of • ■ Mtm il tea.' ' ' gaiaifclprtn v ' Be ha ft 
iuir counts i u ” schuffori.K Schoffcri 
FUMIGATION OR DISINFECTION TREATMENT 
FUMTGASI ATAU PERAWATAN DESINFEKSI 
Date of fumigation Treatment 
Tanggal fumigasi Perawatan 
Duration of exposure Chemical and concentration 
Waktu jang diperlukan 
Additional declaration 
Bahan obat dan konsentrasinja 
Keterangan lain-lainnja 
Charges 
Beaja 
PLANT QUARANTINE SERVICE 
dTnAB KARANTINA TUMBUH a -AN 
4 «|U-M 
Inspector ( 
Pemeriksa 
'TtrA-I-lO fl--A "N'-O- 
This certificate applied only to injurious insects and diseases of the growing crop which are readily capable of detection at the time 
shipment. 
No liability shall attach to the Ministry of Agriculture of Indonesia or to any officer or representative of the Ministry of Agriculture 
the respect of this Certificate. 
