ORIGINAL

1. Goods consigned from
(Exporter's business name, address, country)

Reference No.


CERTIFICATE OF ORIGIN

Asia-Pacific Trade Agreement
(Combined Declaration and Certificate)


Issued in The People’s Republic of China

(Country)

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

3. For Official use

4. Means of transport and route:

5. Tariff
item
number:

6. Marks and
number of
Packages:

7. Number and kind of packages / description of goods:

8. Origin
criterion
(see notes
overleaf)

9. Gross weight
or other quantity

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 (Country)

and that they comply with the origin requirements specified for theses
goods in the Asia-Pacific Trade Agreement for goods exported to\

(Importing Country)

Place and date, signature of authorized Signatory
 12. Certificate

It is hereby certified on the basis of control carried out, that the
declaration by the exporter is correct.

Place and date, signature and Stamp of Certifying Authority