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| | | | | | | ORIGINAL | | | | | | | | 0123456789 |
1. | Goods consigned from (Exporter's business name,address, | | | | | | | | | | | | | | |
| Country) | | | | | | | Reference No. | | | | | | | |
| | | | | | | GENERALIZED SYSTEM OF PREFERENCES |
| | | | | | | CERTIFICATE OF ORIGIN |
| | | | | | | (Combined declaration and certificate) |
2. | Goods consigned to (Consignee's name ,address,country) | | | | | | FORM A |
| | | | | | | | Issued in THE PEOPLE'S REPUBLIC OF CHINA | |
| | | | | | | | | | (COUNTRY) | | | | |
| | | | | | | | | | | | | | See Notes Overleaf | |
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3. | Means of transport and route (as far as known) | | | | | | 4. | For official use | | | | | | | |
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5. | Item | 6. | Marks and | 7. | number and kind of packages;description of goods | | | | 8. | Origin | 9. | Gross | 10. | Number | |
| num- | | numbers of | | | | | | | criterion | | weight | | and date of | |
| ber | | packages | | | | | | | (see Notes | | or other | | invoices | |
| | | | | | | | | | overleaf | | quantity | | | |
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11.Certification | | | | | | | 12.Declaration by the exporter | | | | | | | | |
| It is hereby certified, on the basis of control carried out,that | | | | | | | The undersigned hereby declares that the above details and state- | | | | | | | |
| the declaration by the exporter is correct | | | | | | | ments are correct; that all the goods were produced in | | | | | | | |
| | | | | | | | CHINA | | | | | | | |
| | | | | | | | | | (country) | | | | | |
| | | | | | | | And that they comply with the origin requirements specified for | |
| | | | | | | | those goods in the Generalized System of Preferences for goods ex- | | | | | | | |
| | | | | | | | Ported to | | | | | | | |
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| | | | | | | | | | (importing country) | | | | | |
| | SHEN ZHEN | | | | | | | | | | | | | |
| Place and date,signature and stamp of certifying authority | | | Place and date,signature of authorized signatory | | | | | | | |