附件2
原产地证书格式
ORIGINAL
┌───────────────────────┬───────────────────────────────────────┐
│1.Exporter’s name, address, country: │Certificate No.: │
│ │ │
│ │ CERTIFICATE OF ORIGIN │
├───────────────────────┤ │
│2. Producer’s name and address, if │ Form F for China-Chile FTA │
│known: │ │
│ │ │
├───────────────────────┤ Issued in ____________ │
│3.Consignee’s name, address,country: │ (see Instruction overleaf) │
│ │ │
│ │ │
│ │ │
│ │ │
├───────────────────────┼───────────────────────────────────────┤
│4.Means of transport and route (as far │5. For Official Use Only │
│ as known) │ │
│ │ □ Preferential TariffTreatment Given Under _______ │
│ Departure Date │ │
│ │ □ Preferential Treatment Not Given (Please state reasons) │
│ Vessel /Flight/Train/Vehicle No. │ ………………………………………… │
│ │ Signature of Authorized Signatory of the Importing Country │
│ Port of loading │ │
│ │ │
│Port of discharge ├───────────────────────────────────────┤
│ │6. Remarks │
│ │ │
├────┬──────┬───────────┼─────────────┬──────┬─────────┬────────┤
│7.Item │8. Marks │9. Number and kind │10. HS code │11. Origin │12.Gross weight, │13. Number, │
│number │and numbers │ of packages; │(Six digit code) │criterion │ quantity │date of invoice │
│(Max 20)│on packages │description of goods │ │ │(Quantity Unit) │and invoiced │
│ │ │ │ │ │or other measures │value │
│ │ │ │ │ │(liters,m3,etc) │ │
│ │ │ │ │ │ │ │
├────┼──────┼───────────┼─────────────┼──────┼─────────┼────────┤
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
├────┴──────┴───────────┴──────┬──────┴──────┴─────────┴────────┤
│14．Declaration by the exporter │15．Certification │
│The undersigned hereby declares that the │It is hereby certified, on the basis of control │
│above details and statement are correct, that all the goods │carried out, that the declaration of the exporter is correct. │
│were produced in │ │
│ │ │
│__________________________________________ │ │
│ （Country） │__________________________________________ │
│and that they comply with the origin requirements │Place and date*, │
│specified in the FTA for the goods exported to │ signature and stamp of certifying authority │
│ │ │
│______________________________________________ │Certifying authority │
│ （Importing country） │Tel: │
│ │Fax: │
│_____________________________________________ │Address: │
│Place and date, signature of authorized signatory │ │
│ │ │
│ │ │
└──────────────────────────────┴────────────────────────────────┘
