Form E - Asean-Chinafree Trade Area Preferential Tariff Certificate Of Origin
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1
2Original (Duplicate/Triplicate)
Reference No.
1. Products consigned from (Exporter's business name,
ASEAN-CHINA FREE TRADE AREA
address, country)
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)
2. Products consigned to (Consignee's name, address,
FORM E
country)
Issued in ______________
(Country)
See Overleaf Notes
3. Means of transport and route (as far as known)
4. For Official Use
Departure date
Preferential Treatment Given
Vessel's name/Aircraft etc.
Preferential Treatment Not Given (Please
state reason/s)
Port of Discharge
..................................................................................
Signature of Authorised Signatory of the Importing
Party
5. Item
6. Marks and
7. Number and type of
8. Origin criteria
9. Gross
10. Number and
number
numbers on
packages, description of
(see Overleaf
weight or
date of
packages
products (including quantity
Notes)
other quantity
invoices
where appropriate and HS
and value
number of the importing
(FOB)
Party)
11. Declaration by the exporter
12. Certification
The undersigned hereby declares that the above
It is hereby certified, on the basis of control
details and statement are correct; that all the products
carried out, that the declaration by the
were produced in
exporter is correct.
.............................................................
(Country)
and that they comply with the origin requirements
specified for these products in the Rules of Origin
for the ACFTA for the products exported to
.............................................................
(Importing Country)
.............................................................
Place and date, signature of
authorised signatory
................................................................................
13
Place and date, signature and stamp of
□ Issued Retroactively
□ Exhibition
certifying authority
□ Movement Certificate
□ Third Party Invoicing
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