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原产地证明书样本(DOC)
原产地证明书样本
原产地证书是证 明货物的生产或制造地的文件，简称原产地证，原产地证
书在国际贸易中往往被进口国用来作为实行区别 关税待遇和实施国别贸易政策
管理的重要依据，例如最惠国待遇、政府采购、保障措施的正确实施等等， 因
此具有待定的法律效力和经济作用。下面是亚太贸易协定的原产地证明书，供
大家参考。
SAMPLE CERTIFICATE OF ORIGIN
Asia-Pacific Trade Agreement
(Combined declaration and certificate)
consigned from:
(Exporter’s businename, address, country)
Reference No.
Issued in „„„„„.
(Country)
2. Goods consigned to:
(Consignee’s name, address, country)
Official use
4. Means of transport and route:
item number:6. Marks and number of Packages: 7. Numberand kind of
packages
description
of goods:
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8. Origin
criterion
(see notes
overleaf)9. Gross
weight
or other
quantity:10. Number and date of invoices:
11. Declaration by the exporter :
The undersigned hereby declares that the above details and statementsare
correct: that all the goods were produced in
„„„„„„„„„„„„.
(Country)
and that they comply with the origin requirements specified for thesegoods in
the Asia-Pacific Trade Agreement for goods exported to„„„„„„„„„„„„.
(Importing Country)
„„„„„„„„„„„„.
Place and date, signature of authorized
Signatory 12. Certificate
It is hereby certified on the basis of control carried out, that thedeclaration by
the exporter is correct.
„„„„„„„„„„„„„
Place and date, signature and Stamp of
Certifying Authority
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Notes for completing Certificate of Origin
I. General Conditions:
To qualify for preference, products must:
a) fall within a description of products eligible for preference inthe list of
concessions of an Asia-Pacific Trade Agreement country ofdestination;
b) comply with Asia- Pacific Trade Agreement rules of origin. Eacharticle in a
consignment must qualify separately in its own right;and
c) comply with the consignment conditions specified by the Asia- Pacific Trade
Agreement rules of origin. In general, products must beconsigned directly within the
meaning of Rule 5 hereof from thecountry of exportation to the country of
destination.
s to be made in the boxes
Box1Goods Consigned from
Type the name, addreand country of the exporter. The name must be thesame
as the exporter described in the invoice.
Box2Goods Consigned to
Type the name, addreand country of the importer. The name must be thesame
as the importer described in the invoice. For third party trade,the words “To Order”
may be typed.
Box3For Official Use
Reserved for use by certifying authority.
Box4Means of Transport and Route
State in detail the means of transport and route for the productsexported. If the
LC terms etc. do not require such details, type“By Air” or “By Sea”. If the products
are transported through athird country this can be indicated as follows: e.g. “By
Air”“Laos to India via Bangkok”
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Box5Tariff Item Number
Type the 4-digit HS heading of the individual items.
Box6Marks and Numbers of Packages
Type the marks and numbers of the packages covered by the
information should be identical to the marks and numbers on thepackages.
Box 7 Number and Kind of Packages; Description of Goods
Type clearly the description of the products exported. This should beidentical to
the description of the products contained in the accurate description will
help the Customs Authority of thecountry of destination to clear the products
quickly.
Box8Origin Criterion
Preference products must be wholly produced or obtained in theexporting
Participating State in accordance with Rule 2 of the Asia-Pacific Trade Agreement
Rules of Origin, or where not wholly producedor obtained in the exporting
Participating State must be eligibleunder Rule 3 or Rule 4.
a) Products wholly produced or obtained: enter the letter “A” inBox 8.
b) Products not wholly produced or obtained: the entry in Box 8should be as
follows:
letter “B” in Box 8, for products which meet the origincriteria according
to Rule 3. Entry of letter “B” would be followedby the sum of the value of materials,
parts or produce originatingfrom non-Participating States, or undetermined origin
used, expressedas a percentage of the f.o.b. value of the products; (example “B”50
per cent);
letter “C” in Box 8 for products which meet the origincriteria according
to Rule 4. Entry of letter “C” would be followedby the sum of the aggregate content
originating in the territory ofthe exporting Participating State expressed as a
percentage of thef.o.b. value of the exported product; (example “C” 60 per cent);
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letter “D” in Box 8 for products which meet the specialorigin criteria
according to Rule 10.
Box 9 GroWeight or Other Quantity
Type the groweight or other quantity (such as pieces, kg) of theproducts
covered by the Certificate.
Box 10 Number and Date of Invoices
State number and date of the invoice in question. The date of theinvoice
attached to the Application should not be later than the dateof approval on the
Certificate.
Box 11 Declaration by the Exporter
The term “Exporter” refers to the shipper who can either be atrader or a
manufacturer. Type the name of the producing country andthe importing country
and the place and date when the declaration ismade. Thisbox must be signed by the
Company’s authorized 12 Certification
The certifying authority will certify in this Box.
原产地证书样本亚太贸易协定（中文文本仅供参考）
(申报和证书合一)
1.货物运自(出口人名称、地址、国家)：
编号：
„„„„„. „. „. „. „.签发
(国家)
2.货物运至(收货人名称、地址、国家)：3.官方使用
4.运输工具及路线
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5.税则号列6.包装唛头及编号7.包装件数及种类 ;货物名称8.原产地标准(见
背页说明)9.毛重或者其他数量10.发票编号及日期
11.出口人声明
下列签字人证明上述资料及申明正确无讹，所有货物产自
„„„„„„„„„„„„.
(国家)
且符合亚太贸易协定原产地规则的相关规定，该货物出口至
„„„„„„„„„„„„.
(进口国)
„„„„„„„„„„„.
申报地点、日期及授权签字人的签字12.证明
根据所实施的监管，兹证明上述出口商的申报正确
„„„„„„„„„„„„„
地点和日期，签字和签证机构印章
背页填制说明
一、总原则：
享受关税减让优惠的货物必须符合以下条件：
1.属于《亚太贸易协定》进口成员国关税减让优惠产品清单的范围。
2.符合《亚太贸易协定》原产地规则。同批货物中的每项商品均要符合该规
则。
3 .符合《亚太贸易协定》原产地规则中的直接运输条款规定。一般情况下，
货物必须按照第五条的规定从 出口国直接运输到进口国。
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二、表格各栏应填写的内容：
第1栏：货物出口人。注明出口人的全称、地址和国家。须与发票上的出
口人名称一致。 第2栏：货物收货人。注明收货人的全称、地址和国家。该收货人名称必
须与发票上的进口商名称一 致。如果属于第三方贸易，应该注明“凭背书”字
样。
第3栏：官方使用。由签发证书机构填写。
第4栏：运输工具和线路。详细注明出口货物的运 输工具和路线。如果信
用证等单证未详细列明时，应注明“空运”或“海运”字样;如果货物运输途中经 过
第三国时，应当按照下列方式注明：
例如：“空运” “从老挝至印度途经曼谷”
第5栏：税则号列。注明各项商品的4位HS编码。第6栏：包装唛头及编
号。注明包装上的唛头及编 号。应当与货物包装上的唛头及编号相一致。
第7栏：包装件数及种类；货物名称。注明出口货物名称 。应当与发票上
的名称相符。准确的货物名称有助于进口国海关快速清关。
第8栏：原产地标 准。享受关税减让优惠的货物必须符合《亚太贸易协
定》原产地规则第二条规定，是在出口成员国完全获 得或者生产的;或者在出口
成员国非完全获得或者生产的符合原产地规则第三条、第四条规定的。
1.完全获得或者生产的：在第8栏中填写字母“A”
2.非完全获得或者生产的：在第8栏中应当按照下列方式填写：
(1)如果符合第三条规定 的原产地标准，则在第8栏中填写字母“B”。在字母
“B”的后面填上使用非成员国原产或不明原产地 的材料、零件或产物的总价值，
以在船上交货价格(FOB价格)中所占的百分比表示，(如“B”50 %);(2)如果符合第四
条规定的原产地标准，则在第8栏中填写字母“C”。在字母“C”的后面填 上在出口
成员国原产成分的累计总和，以占出口货物的成本加运费、保险费价格(CIF价
格) 的百分比表示，(如“C”60%);
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(3)如果符合原产地规则第十条规定的特殊比例标准，则第8栏中填写字母
“D”;
第9栏：毛重或者其他数量。注明货物毛重或其他数量(如件数、公斤)。
第10栏：发票编 号及日期。注明发票编号及日期。随附发票上的日期不应
当迟于原产地证书格式正式启用的日期。 第11栏：出口人声明。“出口人”是指发货人，该发货人可以是贸易商也可
以是制造商。声明中应 当注明原产国、进口国、地址和日期。且该栏目应当由
公司授权人员签名。
第12栏：证明。本栏目由签证机构签章确认。
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