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ORIGINAL
Products consigned form (Exporter’s business Reference NO.
name ,address ,country)
Products consigned to (consignee’s name address ,country)
ASEAN-CHINA FREE TRADE AREA PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)
FORM E
MEANS OF TRANSPORT AND ROUTE (AS FAR AS KNOWN)
Issued in
For Official Use
(Country)
See Overleaf Notes
Departure date
Vessel’s name/Aircraft etc. Port of discharge
Preferentia Treatment Given
Preferential Treatment Not Given(Please state reasons)
Signature of Authorised Signatory of the Improting Party
Item 6.Marks and 7.Number
and type
of 8.Origin
9.Gross weight or 10.Number and date of
numb
numberson packages,description
of criteria
other quantity invoices
er
packages
products(including
quantity
where
(see
and value(FOB)
appropriate and HS
number
of the
overleaf
importing Party)
notes)
11.Declaration by the exporter 12.Certification
The undersigned hereby declares that the above details and It is hereby certified , on the basis of control carried
statement are correct;that all the products were produced in out ,that the declaration by the exporter is correct.
(Country)
And that they comply with the origin requirements specified for these products in the rules of origin for the ACFTA for the products exprted to
(Importing Country)
13.
Place and date,signature of Authorized signatory
Place and date, signature and stamp of certifying
Issued Retroactively Movement certificate
Exhibition
Third Party Invoicing
authority
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