东盟FORM-E1 (4)

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1. Goods consingned from (exporter’s business name, address, country) Reference No.

我司抬头
ASEAN-CHINA FREE TRADE AREA
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
2. Goods consigned to (consignee’s name, address, country)
(Combined Declaration and Certificate)
收货人名称及地址
FORM E
Issused in THE PEOPLE’S REPUBLIC OF CHINA
Coumtry)
See Notes overleaf
3. Means of transpor and route (as for as known) 4.For official use
Preferential Treatment Given Under ASEAN-CHINA
Departure Date 开船日期 Free Trade Area Preferential Tariff
Vessel’s Name 船名航次 Preferential Treatment Not Given (pleae state
Port of Discharge 目的港 reason/s)
起运港:

Signature of Authorised Signatory of the Imprting Country


5 6.Marks and 7.Number and type of packages, description of goods 8.Origin criterion 9.Gross weight or other 10.Number and date
.I numbers on (including quantity where appropriate and HS number of (see Notes quantity and value (FOB) of invoices
r packages the importing Country) overleaf) 数量及 FOB 金额 发票号码及日期
唛头 品名及 HS 编码
PE
品名 数量
HS CODE: 货值 发票号码及日期

TOTAL:件数

(此处可填写生产商,或者离岸公司)

11.Declaration by the exporter 12.Certification


The undersigned hereby declares that the above details and
Statement are correct, that all the goods were produced It is hereby certified, on the basis of control carried out , that
CHINA the Declaration by the exporter is correct.
(Country)
and that they comply with the origin requirements specified for these goods in the
ASEAN-CHINA Free trade Area referential Tariff for the goods exported to

(Importing Country)
SHENZHEN.
Place and date.Signature of authorized signatory SHENZHEN.
13. Place and date, Signautre and stamp of certifying authoriy
□ Issued Retroactively □ Exhibition
□ Movement Certificate □ Third Party Invoicing

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