附件5：

中国—智利自由贸易区原产地证书样本及其填制说明

Certificate of Origin

ORIGINAL

Overleaf Instruction

Box 1: State the full legal name, address (including country) of the exporter.

Box 2: State the full legal name, address (including country) of the producer. If more than one producer’s good is included in the certificate, list the additional producers, including name, address (including country). If the exporter or the producer wishes the information to be confidential, it is acceptable to state “Available to the competent governmental authority upon request”. If the producer and the exporter are the same, please complete field with “SAME”. If the producer is unknown, it is acceptable to state "UNKNOWN".

Box 3: State the full legal name, address (including country) of the consignee.

Box 4: Complete the means of transport and route and specify the departure date, transport vehicle No., port of loading and discharge.

Box 5: The customs authorities of the importing country must indicate (√ ) in the relevant boxes whether or not preferential tariff treatment is accorded.

Box 6: Customer’s Order Number, Letter of Credit Number, and etc. may be included if required. If the invoice is issued by a non-Party operator, the name, address of the producer in the originating Party shall be stated herein.

Box 7: State the item number, and item number should not exceed 20.

Box 8: State the shipping marks and numbers on the packages.

Box 9: Number and kind of package shall be specified. Provide a full description of each good. The description should be sufficiently detailed to enable the products to be identified by the Customs Officers examining them and relate it to the invoice description and to the HS description of the good. If goods are not packed, state “in bulk”. When the description of the goods is finished, add “***” (three stars) or “ \ ” (finishing slash).

Box 10: For each good described in Box 9, identify the HS tariff classification to six digits.

Box 11: If the goods qualify under the Rules of Origin, the exporter must indicate in Box 11 of this form the origin criteria on the basis of which he claims that his goods qualify for preferential tariff treatment, in the manner shown in the following table:

Box 12: Gross weight in Kilos should be shown here. Other units of measurement e.g. volume or number of items which would indicate exact quantities may be used when customary.

Box 13: Invoice number, date of invoices and invoiced value should be shown here.

Box 14: The field must be completed, signed and dated by the exporter. Insert the place, date of signature.

Box 15: The field must be completed, signed, dated and stamped by the authorized person of the certifying authority. The telephone number, fax and address of the certifying authority shall be given.

中国—智利自由贸易区原产地证书填制说明

第一栏：注明出口人合法的全称、地址（包括国家）。

第二栏：注明生产商合法的全称、地址（包括国家）。如果证书包含一个以上生产商的商品，应该列出其他生产商的名称、地址（包括国家）。如果出口人或生产商希望对该信息予以保密，可以填写“应要求提供给主管政府机构（Available to competent governmental authority upon request）”。如果生产商和出口人相同，应填写“同上（SAME）”。如果不知道生产商，可填写“不知道（UNKNOWN）”。

第三栏：注明收货人合法的全称、地址（包括国家）。

第四栏：注明运输方式和路线，并详细说明离港日期、运输工具号、装货港和卸货港。

第五栏：由进口方的海关当局在该栏简要说明根据协定是否给予优惠待遇。

第六栏：如有要求，该栏可注明客户订单编号、信用证编号等。如果发票由非成员方经营者出具，应在此栏填写原产国生产商的名称、地址及国家。

第七栏：注明项目编号，但不得超过20个。

第八栏：注明包装上的运输唛头及编号。

第九栏：注明包装数量及种类，并列明每种货物的详细名称，以便查验的海关官员可以识别，并使其能与发票上的货名及HS编码上的货名相对应。如果货物无包装，应注明“散装（IN BULK）”。货物描述结束后，应在后面添加“***”或“＼”（截止符）。

第十栏：对应第九栏中的货物名称注明相应的协调制度编码，以六位编码为准。

第十一栏：若货物符合原产地规则，出口人必须按照下表中规定的格式，在本证书第十一栏中注明其申报货物享受优惠待遇所依据的原产地标准。

第十二栏：该栏应注明毛重的公斤数，其他按惯例能准确表明数量的计量单位，如体积、件数等也可用于该栏。

第十三栏：应注明发票号、发票日期及发票价值，发票价值填写FOB价。

第十四栏：该栏必须由出口人填写，签名、签署日期和加盖印章。

第十五栏：该栏必须由签证机构经授权的签证人员签名、签署日期并加盖签证印章，并应填写签证机构的电话号码、传真及地址。

中国—智利自由贸易区原产地证书样本及其填制说明