* A Certificate of Origin under China-Chile Free Trade Agreement shall be valid for one year from the date of issue in the exporting country.
Overleaf Instruction
Box 1：State the full legal name， address （including country） of the exporter.
Box 2： State the full legal name， address （including country） of the producer. If more than one producer’s good is included in the certificate， list the additional producers， including name， address （including country）. If the exporter or the producer wishes the information to be confidential， it is acceptable to state “Available to the competent governmental authority upon request”. If the producer and the exporter are the same， please complete field with “SAME”. If the producer is unknown， it is acceptable to state "UNKNOWN".
Box 3： State the full legal name， address （including country） of the consignee.
Box 4：Complete the means of transport and route and specify the departure date， transport vehicle No.， port of loading and discharge.
Box 5： The customs authorities of the importing country must indicate （√ ） in the relevant boxes whether or not preferential tariff treatment is accorded.
Box 6：Customer’s Order Number， Letter of Credit Number， and etc. may be included if required. If the invoice is issued by a non-Party operator， the name， address of the producer in the originating Party shall be stated herein.
Box 7： State the item number， and item number should not exceed 20.
Box 8： State the shipping marks and numbers on the packages.
Box 9：Number and kind of package shall be specified. Provide a full description of each good. The description should be sufficiently detailed to enable the products to be identified by the Customs Officers examining them and relate it to the invoice description and to the HS description of the good. If goods are not packed， state “in bulk”. When the description of the goods is finished， add “***” （three stars） or “ \ ” （finishing slash）.
Box 10： For each good described in Box 9， identify the HS tariff classification to six digits.
Box 11： If the goods qualify under the Rules of Origin， the exporter must indicate in Box 11 of this form the origin criteria on the basis of which he claims that his goods qualify for preferential tariff treatment， in the manner shown in the following table：
┌───────────────────────────┬────────┐
│The origin │Insert in Box 11│
│ criteria on the basis of which the exporter claims │ │
│that his goods qualify for │ │
│ preferential tariff treatment │ │
│ │ │
├───────────────────────────┼────────┤
│Goods wholly │P │
│ obtained │ │
├───────────────────────────┼────────┤
│General rule as │RVC │
│ ≥ 40% regional value content │ │
├───────────────────────────┼────────┤
│Products │PSR │
│ specific rules │ │
└───────────────────────────┴────────┘
Box 12：Gross weight in Kilos should be shown here. Other units of measurement e.g. volume or number of items which would indicate exact quantities may be used when customary.
Box 13：Invoice number， date of invoices and invoiced value should be shown here.
Box 14：The field must be completed， signed and dated by the exporter. Insert the place， date of signature.
Box 15：The field must be completed， signed， dated and stamped by the authorized person of the certifying authority. The telephone number， fax and address of the certifying authority shall be given.
原产地证书格式（中文译文仅供参考）
┌──────────────────────┬─────────────────┐
│1.出口商的名称、地址、国家 │证书号： │
│ │ │
│ │原产地证书 │
├──────────────────────┤中国－智利自贸区FORM F │
│2.生产商的名称、地址，在已知情况下 │签发国______________ │
│ │（填制方法详见证书背面注释） │
│ │ │
├──────────────────────┼─────────────────┤
│3.收货人的名称、地址、国家 │5.供官方使用 │
│ │ 可享_____自贸区优惠待遇 │
├──────────────────────┤ │
│4．运输方式及路线（就所知而言） │ 不能享受_______自贸区优惠待遇 │
│离港日期 │ │
│船只/飞机/火车/货车编号 │理由：…………………………… │
│装货口岸 │…………… │
│到货口岸 │进口国官方机构的授权人手签 │
│ │ │
│ │ │
│ │ │
│ ├─────────────────┤
│ │6．备注： │
├──┬───┬───────────┬───┼────┬─────┬──────┤
│7.项│8.唛头│9.包装数量及种类，商品│10. HS│11.原产 │12.毛重、 │13.发票号、 │
│目号│及包装│名称 │编码 │地标准 │数量（数量│发票日期及发│
│（最│号 │ │(以六 │ │单位）或其│票价格 │
│多20│ │ │位编码│ │它计量单位│ │
│项）│ │ │为准) │ │(升、立方 │ │
│ │ │ │ │ │米等) │ │
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
│ │ │ │ │ │ │ │
├──┴───┴───────────┴─┬─┴────┴─────┴──────┤
│14．出口商申明 │15．证明 │
│下列签字人证明上述资料及申明正确无误，所│根据所实施的监管，兹证明上述出口商的申│
│有货物产自 │报正确。 │
│ │ │
│ （XX国家） │ │
│且符合自贸区原产地规则的相关规定，该货物│ │
│出口至 │ │
│ │ │
│ │ 地点、日期*、签字及签证机构印章 │
│ │ │
│ （XX进口国） │签证机构 │
│ │ │
│ │电话 传真 │
│ │ │
│ │地址 │
│ │ │
│申报地点、日期及授权签字人的手签 │ │
└────────────────────┴───────────────────┘
