哥斯达黎加产地证样式

1?.5¿smber, d¿ts
bf &voit* and
hiüiced value
l}.S€clarátisfi by tb*
sapori6r
'14.Ce$ifidatiün
.
The undersigned hereby Ceclares that lhe atlove stated iíf*.rnaiiür¡ i$ egrreüt, arld th.á attihe good$ sre Brcdured ¡n CHINA
3.
lnp#Hs]wr'6. aald¡e. oú.{'W 159üec
rñ
the People's Fepublic
¡f
China
isee Overleaf lnstructíon)
4.Méans 6{ tlángrér!
aid rúü{é
(¿s fár as knd,tn}
Fqr Offici*t Uss.Cnly:
Certlflcate of Orlgln
1. Exporter's name, address, country:
Certificate No.:
CERTIFICATE OF ORIGIN
2. Producer's name and address, if known:
Form for Ghina-Gosta Rica Free Trade Agreement
of goods
9. HS code
(6 digit code)
on packages
10. Origir 11. Gross weight criterion or other quantity (e.9. Quantity Unit, liters, m3.)
12. Number, date of invoice and lnvoiced
value
.?*
'l3.Declaration by the exporter The undersigned hereby declares that the above stated information is correct, and that all the goods are produced in
lssued
in
THE PEOPLE',S REPUBLTC OF CHTNA
(see Overleaf lnstruction)
3.lmporter's name, address, country:
For Official Use Only:
4.Means of transport and route (as far as known)
Departure Date:
5. Remarks:
Vessel/FlighVTrainA,/ehicle No.
:
Port of loading:
Port of discharge:
6.ltem number
(Max.201
7. Marks and Numbers
8. Number and kind of packages; Description
On lhe basis of ttte carried out cantroi, it ¡g
hffe*y
¿éltiñed lhát thé iñfurmatiq¡!
he€ln is @rrecl afld tnát lhe des¿r¡bed goüds coflply with ihe origin r€qu;iefrenis
0Rrfflr{AL
i . Éxportér's ntüe" add{*s$,stun$y:
e**fficate llo.:
CERTfFÍC.ATÉ OF $RIGI}ü
2
Fródücer's námé.añd adiJres.s, íf krlown:
Fsrñi fcr Cllinfi-Cs3ta Rica Free Tr¿de Agreemant
CHINA (Country) and that they comply with the origin requirements specified in the Free Trade Agreement for the goods exported to COSTA RICA
l4.Certification
*a
*j*&iátd !: {lr$):Í ¿rM ile
üb@-lcsln ql* Ére6 f rde É,gf*Érl $a! ¡¿ rátrJ lit ¡:+j lstr f4á :lÉ dats íf ¡*' ja¡4¡ rr thÉ
",1¡!f:Ji!¡
e.t&
CCPIT
1S
¡
0CI000CI0
ot th€ Clliñá -Cosh Rica Frge Tradé Agreer¡rent.
i*o{¡¡try}
.
:
ang lhát they cor:rply w¡ih the orqin requiremenls cpec¡lied ifi al'!* Fró€ Írádc Agreerflár'rt lor thé g*ódc €xpqdcd to
6.lie:F.
qt Fac¡{agcsl0eeeript¡*n ot
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H3 mda
fi$nb6r
{Mex.
l0}
ís digitcldé¡
10 Otigin 11. €rü$$ w€ight :rilér¡óñ ar dtlrer ql}asliiy
{€.g. *uflñlrty Un1t, liter6, r¿'.)'
AQSIQ
110000018
wenku.baidu.com
On the basis of the canied out control, it is hereby certified that the information herein is conect and that the described goods comply with the origin requirements of the China -Costa Rica Free TradeAgreement.
Depa{ur* 0atéi
Vcsssi lFliglrtñ¡atfllvshiü¡a No.:
Fsrl sl ioudins:
Fora {t¡
5- R6marks:
disrhá€a:
?. Mári{s dnd Nuorb¿r3 afi paükageg 8. Num&ér end (iñd
goodB
ü{3STA fi'CA
illn.périiñg f.ot¡ntry] Figr€ áñd da1é*. sigf¡áture and Blémp efl¡é Aulh*ri¿Éd Body
Tel: Aridrssgl
Pls6*, d'áts ánd stgn$ure of ev1lÉr¡?€d !€rson
Place and date*, signature and stamp of the Authorized Body
(lmporting country)
Tel:
Address
Place, date and signature of authorized person
*
A Certificate of Origin issued under China-Costa Rica Free Trade Agreement shall be valid for one year from the date of issuance ¡n the exporting countr)