ANEXO 4
Certificate of Origin
1. Exporter’s name, address, country:
出口商
Certificate No.:
CERTIFICATE OF ORIGIN
Form F for China-Chile FTA
Issued in ____________
(see Instruction overleaf)
2. Producer’s name and address, if known:
生产商
3. Consignee’s name, address, country:
收货商/地址/电话等
4.Means of transport and route (as far as known)
Departure Date 离港日期
Vessel /Flight/Train/Vehicle No. 运输方式
Port of loading 起运港
Port of discharge 目的港
5. For Official Use Only
Preferential Tariff Treatment Given Under _______
Preferential Treatment Not Given (Please state reasons)
…...…………………………………………
Signature of Authorized Signatory of the Importing Country
6. Remarks
备注（信用证号、订单编号等）此栏不可空，如不填写可打“***********”
7.Item number
(Max 20)
项目编号（序号）
8. Marks and numbers on packages
唛头
此栏不能空，无唛头则填打“N/M”
9. Number and kind of packages; description of goods
品名
*************************
10. HS code
(Six digit code)
HS编码
11. Origin criterion
原产地MATCH_
word
word文档格式规范word作业纸小票打印word模板word简历模板免费word简历
_1714164745362_0
12. Gross weight, quantity (Quantity Unit) or other measures (liters,m3,etc)
数量/重量/
13. Number, date of invoice and invoiced value
发票号
发票日期
发票货值
14．Declaration by the exporter
The undersigned hereby declares that the above details and statement are correct, that all the goods were produced in
CHINA
（Country）
and that they comply with the origin requirements specified in the FTA for the goods exported to
CHILE
（Importing country）
（我司盖章签字）
SHENZHEN,日期,2010
Place and date, signature of authorized signatory
15．Certification
It is hereby certified, on the basis of control carried out, that the declaration of the exporter is correct.
****************************************
Place and date , signature and stamp of certifying authority
Certifying authority
Tel: Fax:
Address:
ORIGINAL
A Certificate of Origin under China-Chile Free Trade Agreement shall be valid for one year from the date of issue in the exporting coun
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