1.Exporter’s name, address, country:

Certificate No.: 

CERTIFICATE OF ORIGIN

Form F for China-Chile FTA

Issued in

(see Instruction overleaf)

2.Producer’s name and address, if known:

(没有工厂地址打标准格式)

3. Consignee’s name, address, country:

5.  For Official Use Only

                  Preferential Tariff Treatment Given Under _______

                 Preferential Treatment Not Given (Please state reasons)

Signature of Authorized Signatory of the Importing Country

4. Means of transport and route (as far as known)

Departure Date:ON/AFTER 31ST.DEC2011

  Vessel /Flight/Train/Vehicle No:STADT AACHENV.152E  BY SEA

  Port of loading:YANTIAN,CHINA

  Port of discharge:VALPARAISO,CHILE

6.  Remarks

金小姐13715202292     075525175060

QQ：  411933245

MSN：sharon259758@hotmail.com

邮箱：tong-can668@163.com

7. Item

number

(Max. 20)

8. Marks and

numbers

on packages

9. Number and kind of packages;

  description of goods

10. HS code

(Six digit code)

11. Origin

criterion

12. Gross weight, quantity (Quantity Unit) or other measures (liters, m3, etc)

13. Number, date ofinvoiceandinvoicedvalue

1

N/M

T-SHIRT  FOR  LADIES

TOTAL：FORTY THREE (43) CTNS ONLY.

“P”

6109909052

CHINA

2228PCS

No.20111220

DEC..15,2011

USD：58,642.20

14.  Declaration by the exporter

The undersigned hereby declares that the above details and statement are correct, that all the goods were produced in

(Country)

and that they comply with the origin requirements specified in the FTA for the goods exported to

（Importing country)

Place and date, signature of authorized signatory

15.  Certification

It is hereby certified, on the basis of control carried out, that the declaration of the exporter is correct.

Place and date[*], signature and stamp of certifying authority

Certifying authority

Tel:                                                   Fax:   

Address: