Phụ lục V GIẤY CHỨNG NHẬN XUẤT XỨ MẪU E (C/O MẪU E) (Ban hành kèm theo Quy chế cấp C/O mẫu E) Lưu

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Phụ lục V GIẤY CHỨNG NHẬN XUẤT XỨ MẪU E (C/O MẪU E) (Ban hành kèm theo Quy chế cấp C/O mẫu E)

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Phụ lục VGIẤY CHỨNG NHẬN XUẤT XỨ MẪU E (C/O MẪU E)(Ban hành kèm theo Quy chế cấp C/O mẫu E)Original (Duplicate/Triplicate/Quadruplicate) Reference No. 1. Goods consigned from (Exporter'sbusiness name, ASEAN-CHINA FREE TRADE AREA address, country) PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) 2. Goods consigned to (Consignee'sname, address, FORM E country) Issued in ______________ (Country) See Notes Overleaf 3. Means of transport and route (asfar as known) 4. For Official Use Departure date Preferential Treatment Given UnderASEAN-CHINA Free Trade Area Preferential Tariff Vessel's name/Aircraftetc. Preferential Treatment Not Given(Please state reason/s) Port of Discharge .................................................................................. Signature of Authorised Signatory of theImporting Country 5. Item 6. Marksand7. Number andtype of8. Origincriterion 9. Gross 10. Numberand number numbers on packages,description of (see Notes weight or date of packages goods (includingquantity overleaf) otherquantity invoices where appropriateand HS and value number of theimporting (FOB) country) 11. Declaration by the exporter 12. Certification The undersigned hereby declares It is hereby certified, on the basis of control that the above details and statement are correct;that all the goods carried out, that the declaration by the were produced in exporter is correct. ............................................................. (Country) and that they comply with the originrequirements specified for these goods in theASEAN-CHINA Free Trade Area Preferential Tarifffor the goods exported to ............................................................. (Importing Country) ............................................................. ................................................................................Place and date, signature of Place and date, signature and stamp ofauthorised signatory certifying authority OVERLEAF NOTES1. Member States which accept this form for the purpose of preferential treatmentunder the ASEAN-CHINA Free Trade Area Preferential Tariff:BRUNEI DARUSSALAM CAMBODIA CHINAINDONESIA LAOS MALAYSIAMYANMAR PHILIPPINES SINGAPORE