1.      Exporter’s name, address, country:

SHEN ZHEN HONGCUI INDUSTRIAL CO.,LTD.CHINA

Certificate N°:

CERTIFICATE OF ORIGIN

Form F for China-Chile FTA

Isued in_____________

2.     

2. 生產商名字，地址，如有。

Producer’s name and address, if know:

SHEN ZHEN HONGCUI INDUSTRIAL CO.,LTD.CHINA

3.     

3. 收貨人名字，地址及國家。

Consignee’s name, address, country:

TO THE ORDER

4. 運輸方式; 離港日期; 航次號碼; 離開港口; 到達港口;

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

Departure Date:                            OCT 11^TH,2006

Vessel/Flight/Train/Vehicle N°:    BY SEA

Port of loading:                             SHENZHEN,CHINA

Port of discharge:                         CHILE

5.      Preferential

5. 內部填寫， 無需理會。

For Official Use Only

         Preferential Tariff Treatment Given Under_______

         Preferential Treatment Not Given (Please state  reasons)

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Signature of Authorized Signatory of the Importing Country  

6.備註

6. Remarks

7. 貨品號碼 (最多20項)

10. 產品協制編號 (有6位數字)

9. 每件包裝的件數及貨品的種類

8. 唛头及件數

7. Item number (Max 20)

8. Marks and numbers on packages

Samsung E780

Color:Brown Black

Version:with E786 screen image

QTY:100PCS

Destination:Chile

SEC - Chile

Santiago Airport

Samsung T519C

Color:Black

Version:Generic

QTY:100PCS

Destination:Chile

SEC - Chile

Santiago Airport

9. Number and kind of packages; description of goods

Plastic mock-up phones

MODEL NO.E780 in Brown Black

Plastic mock-up phones

MODEL NO.T519C in Black

请加箱数

10. HS code (Six digit code)

902300

902300

11.

P

P

12. Gross weight,

95KGS

1000PCS

150KGS

1500PCS

11. 產地來源 *注意下面註解

13. Number, date of

12. 毛重， 數量 (單位) 或其他量度 (單位)

251A00806

OCT 11,

请加:美金额

13. 發票的號碼，日期，金額

 

14. 由出口商申報 – 以上必須填上 並填寫申報日期及受權人簽名

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. 証書由認可國家機構及受權人簽名及蓋章。

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