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Certificate of Origin
1. Exporor's name, adress, county
conifeate No.
CERTIFICATE OF ORIGIN
2, Producer's name ang adress, known
{for China-Costa Rica Free Trade Agreement
THE PEOPLE'S REPUBLIC OF Ci
(see Overleaf Instruction)
Issued in
Smporter’s name, adress, county:
For Oficial Use Oni
“4 Means of ransport and route (as far as known)
Departure Date:
VessolilghtTrain/Vehicle No:
5. Remar
Por of oan
Pon of charge
[Sian [7 Mans and Nomber] @ Number and Kind of pockages;Descrpion BLAS code 10. OFgn| 1. Gross wight | 12 Number
ee a (6 cigit —_[oriterion | or other quantity | date of invoice
ar code) (eg. Quantity | and invoiced
Unt tor me) | value
18,Declaration by he exporter
‘The undersigned hereby declares thatthe above stated information is
correct, and that al the goods are produced in
CHINA
{(Countty)
‘and that they comply withthe ongin requirements specie n the
Free Trade Agreement forthe goods exported to.
COSTARICA
{importing county)
Pace, date and signature of authorized person
#.Gorieation|
(On he basis ofthe cared out contra, ts herby atid hat te nformaton
heron erect nd thal he dosed goods coma wi he org rquremers
tthe China Costa Rea Free Trade Agfeonent.
Place and dae’, signature and sta ofthe Authorized Body
Fax
* AContiicato of Origin issued under China-Costa Rica Fro Trade Agreement shal be valid fr one year rom the date of issuance inthe exporting county.
184611158Overleaf Instruction
‘The Engish version of the Gerticate of Origin shal be used and such Ceca shallbe completed in that same language, in accordance with
the overeat instructions established herein,
Box t
Box 2:
Box 3:
Box:
Box6:
Box:
Box
Box 10
‘State the ful egal name, addres ofthe exporter in China or Costa Rica.
‘State the ful legal name, address (including county ) ofthe producer. If more than one produc's good is include in the carticate,
list he adational producers, including name, edaress(incusing county he exporter or te producer wish the infomation o be
confidential, state“ Availabe fo the competent authority or authorized body upon request. the producer and the exporter are the
‘same, please complete the box with * SAME “fhe producer is unknown, state" UNKNOWN"
‘State the ful egal name, adress ofthe importer in China or Costa Rica.
Complete the means of ransport and route and speciy tne departure date, transport vehicle No, port of loading and discharge, as far
as known,
Customers Order Number, Letter of Cred Number, among others, may be included. Ifthe invoice i issued by anon Party operator,
information such as name and county ofthe operator issuing te Invcice shall be indicated herein,
‘State the tern number, and ten ruber shal not excaed 20 the box's space isnot enough. adlinal pages, wth the same form
{2s the first page couldbe attached, Any adstonal page wil have the phrase page of” noted, and the boxes 6 to 14 wil be completed
with the comesponding information
‘State the shipping marks and numbers on packages, when such marks and numbers exit, otherie shall stale“ NO MARKS AND
NUMBERS (N/M)
Number and kind of packages shall be specifed, Provide afl description of each good. The deseripton shoud be sufiienty detailed
tenable the produc tobe identified by the Customs Officers examining them and eat it to the invoice deseration and tothe HS