原产地证书格式(中英)
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附表2
原产地证书格式
ORIGINAL
er’s
name, address, country:
2. Producer’s
name and address, if known:
nee’s name,
address, country:
Certificate No.:
CERTIFICATE OF ORIGIN
Form F for
China-Chile FTA
Issued in ____________
(see Instruction overleaf)
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
of
transport and route (as far as
known)
Departure Date
Vessel
FlightTrainVehicle No.
Port of loading
Port of discharge
number
(Max
20)
8. Marks
and
numbers
on
packages
9. Number and kind of 10. HS 11. Origin
packages; description of code criterion
goods (Six digit
code)
12.
Gross weight,
quantity (Quantity
Unit) or
other
measures
(liters,m3,etc)
13. Number,
date of invoice
and
invoiced
value
14．Declaration by
the exporter
The undersigned hereby declares
that the above
details and statement are
correct, that all the goods
were produced in
（Country）
and that they comply with the origin
requirements
specified in the FTA for the
goods exported to
（Importing country）
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:
* 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.
;.
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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
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 criteria on
the basis of which the exporter claims that his
Insert in Box 11
goods qualify for
preferential tariff treatment
Goods wholly
obtained
General rule as ≥ 40% regional value
content
Products specific rules
P
RVC
PSR
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.
;.
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原产地证书格式（中文译文仅供参考）
证书号：
1.出口商的名称、地址、国家
2. 生产商的名称、地址，在已知情况下
3. 收货人的名称、地址、国家
原产地证书
中国－智利自贸区FORM F
签发国______________
（填制方法详见证书背面注释）
5.
供官方使用
可享受_______ 自贸区优惠待遇
不能享受_______自贸区优惠待遇
理由：…...…………………………………………
进口国官方机构的授权人手签
4．运输方式及路线（就所知而言）
离港日期
船只飞机火车货车编号
装货口岸
到货口岸
7.项目
号（最
多20
项）
8.唛头及
包装号
9.包装数量及种类，商品名称 10. HS 编码
(以六位编码为
准)
6．备注：
11. 原产地标
准
12.毛重、数量
（数量单位）或
其它计量单位
(升、立方米等)
13.发票号、发票日期及
发票价格
14．出口商申明
下列签字人证明上述资料及申明正确无误，所有货物产
自
（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
（XX进口国）
申报地点、日期及授权签字人的手签
15．证明
根据所实施的监管，兹证明上述出口商的申报正确。
地点、日期
*
、签字及签证机构印章
签证机构
电话 传真
地址
1
中国-智利自贸区协定项下的原产地证书应在自出口方签发之日起一年内有效。
;.
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背面说明
第一栏：应填写出口商详细的依法登记的名称、地址（包括国家）。
第二栏：在已知的情况下
填写生产商详细的依法登记的名称、地址（包括国家）。如果证书包含一
个以上生产商的商品，应该列出
其他生产商的详细名称、地址（包括国家）。如果出口商
或生产商希望对信息予以保密，可以填写“应要
求提供给签证机构（Available to
competent
governmental authority
upon request）”。如果生
产商和出口商相同，应填写“相同（SAME）”。
如果不知道生产商，可填写“不知道（UNKNOW
N）”。
第三栏：应填写收货人详细的依法登记的名称、地址（包括国家）。
第四栏：应据
所知填写运输方式及路线、详细说明离港日期、运输交通工具的编号、装货口岸和
到货口岸。
第五栏：不论是否给予优惠待遇，进口方海关必须在相应栏目标注
(√ )。
第六栏：如有要求可以填写顾客顺序号、信用证号等。如果发票是由非缔约方开出的，应在此栏
标注原
产国生产商的名称、地址和国家。
第七栏：应填写项目号，但不得超过20项。
第八栏：应填写唛头及包装号。
第九栏：应详细列明包装数量及种类。对每种货物提供详细的
货物描述，以便于查验的海关关员
可以识别。货物描述应与发票描述及货物的协调制度编码相符。如果是
散装货，应注明
“散装”。当货物描述结束时，加上“***”（三颗星）或“＼”（结束斜线符号）。
第十栏：应对应第九栏中的每种货物填写协调制度编码，以六位编码为准。
第十一栏：若货物
符合原产地规则，出口商必须按照下列表格中规定的格式，在本证书第十一栏
中标明其货物申报享受优惠
待遇所根据的原产地标准。
出口商申报其货物享受优惠待遇所根据的原产地标准 填入第11栏
“P”
(1) 在出口方完全获得的产品
“RVC”
(2)
符合基本标准，即区域价值成分大于等于
40%的产品
(3)
符合产品特定原产地规则的产品
“PSR”
第十二栏：毛重应填写“千克”，可依照惯例，
使用其他计量单位例如体积、数量等来精确地反映
量。
第十三栏：应填写发票号、发票日期及发票价。
第十四栏：本栏必须由出口商填写、签名并填写日期。且应该填写签名的地点及日期。
第十五
栏：本栏必须由签证机构的授权人员填制、签名、填写签证日期并盖章。并应提供签证机
构的电话号码，
传真及地址。
;.