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Closed at $2.

659 on December 20, 2016


TRANSACTION CERTIFICATE

USA FOR PRODUCTS FROM NOP ORGANIC PRODUCTION

I. Body issuing the certificate (name and address) 2 a) The National Organic Program standards of the Uni ted States Department of
Control Union Certifications B.V. Agriculture/Control Union Ce rtifications standards
Meeuwenlaan 4-6 2 b) Reference number of the certifi cate: PRJ 812234/706451
8011 BZ ZWOLLE
NETHERLANDS
3. Seller of the product (name and address) 4. Inspec tion body* (name and address)
Koperasi Pennata Gayo Control Union Certifications B.V.
JI. Syiah Utama. No. 66 Kampung Simpang Utama. Pondok Baru Meeuwen laan 4-6
24582 Bener Meriah 8011 BZ ZWOLLE
Aceh NETHERLANDS
INDONESIA
5. Producer or processor of the product (name a nd address) 6. Country of dispatch
Koperasi Permata Gayo (Bromo Ujung) INDONESIA
JI. Bromo Ujung, Gang lkhlas No. 2Medan
Sumatera U tara
INDONESIA
7 . Consignee (name and address) 8. Country of destination
UN ITED STATES OF AMERICA
Cooperative Coffees Inc.
302 Lamar Street Su ite E
GA 3 I 709 Americus ..
9. Address and place of destination
U NITED STA TES OF AMERICA
I0. Marks and numbers, container no{s), number and kind. Trade name of the product. II. Gross mass
Production Lot/batch Gross mass Net mass
NOP certified
Year numbers (kgs) (kgs) 18300.00 kgs

100% organic Sumatra Pennata Gayo Highland Arabica Coffee (Sumatra Gayo
Mountain Green Arabica Coffee DP Grade-I Organic and Fairtrade Certi fied) 2016 18300.00 18000.00 12. Net mass
packed in Unit 60 kg in 300 bags
18000.00 kgs
from organic production methods.
In voice no.: 014/INV/PGC/2016/2017 d.d. 17-12- 16 13. Alternative units*
Transport document no.: 958824330 d.d. 20-12-16
Container no.: MRKU872490-0
Identification codes: Pennata Gayo Coop Identification Code:O 15/ 1730/14 SUG-173. Seal No.ML-ID 2208852. Shipping Company :
MAERSK LI E ,.

14. Declaration of the body issuing the certificate

15 . Additional declaration (if appropriate)

Certified in compliance wi th the tenns of the US-Canada Organic Equivalency Arrangement.

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16. Place and date of issue Jakarta, 27 December 2016 Stamp of the issuing body

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*Explanatory notes
Box 4: The inspection and certification body for compliance with the rules on from organic production methods ..
Box 5: The finn which carried ou t the last operation (processing, packaging, labelling) on the batch.
Box 9: The address of the finn where the batch will be delivered. if different from the address in box 7.
Box 13: e.g. volume in meters, to be given, where appropriate, in supplement to the declarations in boxes 11 and 12.