1.Exporter

Certificate No.

CERTIFICATE OF ORIGIN

OF

THE PEOPLE'S REPUBLIC OF CHINA

2.Consignee

3.Means of transport and route

5.For certifying authority use only

4.Country / region of destination

11.Declaration by the exporter

The undersigned hereby declares that the above details and statements are correct, that all the goods were produced in China and that they comply with the Rules of Origin of the People's Republic of China.

12.Certification

It is hereby certified that the declaration by the exporter is correct.

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Place and date, signature and stamp of authorized signatory

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Place and date, signature and stamp of certifying authority