普惠制原产地证
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Place and date, signature and stamp of certifying authority
12. Declaration by the exporter
The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in
（country）
and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for goods exported to
（importing country）
4.For official use
5. Item
Number
6. Marks and
numbers of
packages
7. Nunber and kind of packages; description of goods
8. Orign crite- rion（see Notes verleaf）
1. Goods consigned from (Exporter’s business name, address, country)
Reference No:
GENERALIZED SYSTEM OF PREFERENCES
CERTIFICATE OF ORIGIN
(Combined declaration and certificate)
FORM A
Issued inTHE PEOPLE’S REPUBLIC OF CHINA
（country）
See Notes, overleaf
2. Goods consigned to(Consignee’s name, address, country)
3. Means of tranwenku.baidu.comport and route(as far as known)
Place and date, signature of authorized signatory
9. Gross weight or other quantity
10.Number and date of invoices
11. Certification
It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct.
12. Declaration by the exporter
The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in
（country）
and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for goods exported to
（importing country）
4.For official use
5. Item
Number
6. Marks and
numbers of
packages
7. Nunber and kind of packages; description of goods
8. Orign crite- rion（see Notes verleaf）
1. Goods consigned from (Exporter’s business name, address, country)
Reference No:
GENERALIZED SYSTEM OF PREFERENCES
CERTIFICATE OF ORIGIN
(Combined declaration and certificate)
FORM A
Issued inTHE PEOPLE’S REPUBLIC OF CHINA
（country）
See Notes, overleaf
2. Goods consigned to(Consignee’s name, address, country)
3. Means of tranwenku.baidu.comport and route(as far as known)
Place and date, signature of authorized signatory
9. Gross weight or other quantity
10.Number and date of invoices
11. Certification
It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct.