东盟-中国自由贸易区优惠关税原产地证书式样

　 Original 1.Goods consigned from (Exporter′s business name,address,

　 Reference No.

　 country)

　 ASEAN- - CHINA FREE TRADE AREA

　MITSUI COMPONENTS (GUANGDONG) LIMITED

　PREFERENTIAL TARIFF

　SANZAO IND.GARDEN OF SCIENCE

　CERTIFICATE OF ORIGIN

　TECHNOLOGY,JINWAY DISTRICT,

　 (Combined Declaration and Certificate)

　 ZHUHAI GUANGDONG, P.R. CHINA

　 FORM E

　2.Goods consigned to (Consignee′s name,address,country)

　 MITSUI SIAM COMPONENTS CO.,LTD

　 60/8 MOO 3 MABYANGPORN A.PLUAKDAENG

　Issued in THE PEOPLE′S REPUBLIC OF CHINA

　RAYONG ×× THAILAND

　(Country)

　 TEL:

　 FAX:

　 See Notes overleaf

　 3.Means of transport and route(as far as known)

　 4.For official use

　□ Preferential Treatment Given Under ASEAN-CHINA

　Departure date

　 Free Trade Area Preferential Tariff

　 NOV.15,20

　 □ Preferential Treatment Not Given(Please state

　Vessel′s name /Aircraft etc.

　reason/s

　 WAN HAI 272 / S037

　 Port of discharge

　LAEM CHABANG

　……………………………………………………………………………………

　Signature of Authorised Signatory of the Importing Country

　 5.Item 6.Marks and

　 7.Number and type of packages,description 8.Origin criterion 9.Gross weight 10.Number and

　 number

　 numbers on

　 of goods(including quantity where

　(see Notes

　 or other quantity

　date of invoices

　 packages

　 appropriate and HS number of the

　overleaf)

　 and value(FOB)

　 importing Country)

　1 MSC CO.

　LEVER EMERGENCY B

　"WO"

　 1000 PCS

　 MCG131102TF

　 MADE IN CHINA ONE (1) CARTONS ONLY

　USD:100.00

　 NOV.08,20

　 H S. CODE: 8301. 60

　2

　LEVER KEY MANUAL

　"WO"

　 800 PCS

　 ONE (1) CARTONS ONLY

　USD:104.00

　 H S. CODE: 8301. 60

　3

　LEVER OPEN MANUAL

　"WO"

　 1000 PCS

　 ONE (1) CARTONS ONLY

　USD:140.00

　 H S. CODE: 8301. 60

　 4

　CASE FR KEYLESS R

　"WO"

　 4500 PCS

　 ONE HUNDRED AND TWENTY FIVE (125) CARTONS ONLY

　 USD:1710.00

　 H S. CODE: 3926. 90

　5

　CASE FR L

　 "WO"

　 4500 PCS

　ONE HUNDRED AND TWENTY FIVE (125) CARTONS ONLY

　 USD:1710.00

　 H S. CODE: 3926. 90

　6

　CASE RR L

　 "WO"

　 4320 PCS

　 ONE HUNDRED AND TWENTY (120) CARTONS ONLY

　 USD:1555.20

　 H S. CODE: 3926. 90

　7

　CASE RR R

　 "WO"

　 4320 PCS

　 ONE HUNDRED AND TWENTY (120) CARTONS ONLY

　 USD:1512.00

　 H S. CODE: 3926. 90

　8

　COUPLER

　 "WO"

　 880 PCS

　 FOUR (4) CARTONS ONLY

　USD:123.20

　 H S. CODE: 3926. 90

　9

　PROTECTOR

　 "WO"

　 1200 PCS

　 THIRTY (30) CARTONS ONLY

　USD:312.00

　 H S. CODE: 3926. 90

　TOTAL: FIVE HUNDRED AND TWENTY SEVEN (527) CARTONS ONLY

　 *** *** *** *** *** ***

　中文名 HS 编码 金额

　 连杆

　100.00

　连杆

　104.00

　连杆

　140.00

　外壳

　1710.00

　外壳

　1710.00

　外壳

　1555.20

　外壳

　1512.00

　接口

　123.20

　外壳

　312.00

　11.Declaration by the exporter

　 12.Certification

　The undersigned hereby declares that the above details and

　 It is hereby certified,on the basis of control carried out,that the

　Statement are correct;that all the goods were produced in

　 Declaration by the exporter is correct

　 CHINA

　……………………………………………………………………………………

　(Country)

　and that they comply with the origin requirements specified for

　 these goods in the ASEAN-CHINA Free Trade Area Preferential

　Tariff for the goods exported to

　THAILAND

　 ………………………………………………………………………………………

　 Importing Country

　 ………………………………………………………………………

　……………………………………………………………………………………

　Place and date,signature of authorised signatory

　Place and date,signature and stamp of certifying authority