1.Exporter(full name and address) CERTIFICATE No
CERTIFICATE OF ORIGIN OF THE PEOPLE'S REPUBLIC OF CHINA Consignee (full name and address) 3
Means of transport and route 5 For certifying authority use only 4
Destination port 6
Marks and numbers of packages 7
Description of goods; Number and kind of packages; 8
HS CODE 9
Quantity or weight 10
Number and date of invoices 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 Place and date,signature and stamp of authorized signatory 12
Certification It is hereby certified that the declaration by the exporter is correct Place and date,signature and stamp of cer