Triplicate
1.Products consigned from(Exporter’s business name,address, country) Reference No.
ASEAN-CHINA FREE TRADE AREA
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2.Products consigned to (Consignee's name,address,country) (Combined Declaration and Certificate)
FORM E
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3.Means of transport and route (as far as known) 4.For Original use
Departure date □ Preferential Treatment Given
Vessel's name/Aircraft etc.
Port of Discharge
□ Preferential Treatment Not Given(Please state reason/s)
--------------------------------------------------------
Signature of Authorised Signatory of the Importing Party
5.item 6.Marks and 7.Number and type of packages, description of 8.Origin criteria 9.Gross weight or net 10.Number,
number numbers on products (including quantity where appropriate (see Overleaf weight or other date of lnvoices
packages and HS number in six digit code) Notes) quantity, and value
(FOB) only when RVC
criterion is applied
11.Declaration by the exporter 12.Certification
The undersigned hereby declares that the above details and it is hereby certified on the basis of control carried out,that the
Statement are correct,that all the products were produced in
declaration by the exporter is correct
CHINA
---------------------------------------------------
(Country)
and that they comply with the origin requirements specified for these
products in the Rules of Origin for the ACFTA for the
products exported to
---------------------------------------------
(Importing Country)
---------------------------------------------
Place and date,signature of authorised signatory
13.
□ Issued Retroactively □Exhibition ---------------------------------------------------------
□ Movement Certificate □ Third Party Invoicing Place and date,signature and stamp of certifying authority