Form E
Form E
Form E
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)
3. Means of transport and route (as far as known) 4. For Official Use
Port of Discharge
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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)
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.
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(Country)
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(Importing Country)
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Place and date, signature of
authorised signatory ................................................................................