Original
R ef er enc e No. E236788737290003 1. Products consigned from (Exporter's business name, address,
country)
FOSHAN XXX TRADING COMPANY LIMITED
RM XXXX, 1ST BUILDING, YATING INTERNATIONAL PLAZA,
NO. 18 FENJIANG NAN ROAD ,CHANCHENG
DISTRICT,FOSHAN,GUANGDONG,CHINA
2. Products consign ed to (Consign ee's name, a ddr ess, country)
CV XXX BELAWAN
JL. TIMOR KOMP. CENTER POINT BLOK
H-20 , GANG BUNTU MEDAN TIMUR KOTA
MEDAN 20231, INDONESIA
TEL :62-61-XXXXXXX
NPWP: 02. 759. 343. 3-112. XXX
ASEAN-CHINA FREE TRADE ARE唔
PREFERENTIAL TARIFF
CERTIFICATE OF ORIGIN
(Combined and Certificate)
FORM E
Issued in THE PEOPLE'S REPUBLIC OF CHINA
(Country)
See Overleaf Notes
3. Means of transport and rout e (as far as known)
D epartur e dat e JAN. 06, 2023
Vess el's name / Aircraft etc. YUE WAN TONG 318 V. 230106
Port of Discharg e SURABAYA, INDONESIA
FROM TAISHAN,CHINA TO SURABAYA, INDONESIA
4. For Official Use
Verifica tion :origin . . en
口Pr ef erential Tr eatm ent Given
口Pr eferential Tr eatment Not Given (Please state reason/s)
-----------------------------------------
Signature of Authorised Signatory of the Importing Party
5 1t em
|
6. Marks and
Number! numb ers on
packag es
7. Numb er an d type of packag es, d escription
of pro ducts (inclu ding quantity wh er e
appropriat e and HS numb er in six digit co de)
8. Origin crit eria
(se e Ov erl eaf
Notes)
NIM
2
TWO THOUSAND SIX HUNDRED (2600) BOXES OF
UNGLAZED PORCELAIN TILES
: MI COG RESS GST6061
LA BLACK
600X600MM
HS CODE:
ONE THOUSAND EIGHT HUNDRED (1800) BOXES
OF UNGLAZED PORCELAIN TILES
BRAND: MICOGRESS GST6060
LA RED
600X600MM
HS CODE: 6907. 21
*** *** *** *** ***
TOTAL FOUR THOUSAND FOUR HUNDRED
(4400)BOXES ONLY.队即FACTURER: GUANGDONG
XINRUNCHENG CERAMICS CO.,LTD
TAIPING DEVELOPMENT ZONE, XIQIAO,
NANHAI DISTRICT, FOSHAN CITY,CHINA
"PE"
9. Gross weight or net
weight or other quantity,
and valu e (FOB) only
wh en RVC criterion is
applied
3744M2 (SQM)
10. Numb e r,
dat e of
Invoices
2592M2 (SQM)
FST/PI/01/
XII/22
JAN. 05,2023
"PE"
，
媪
11. Declaration by th e exporter
The un dersigne d h ereby declares that th e abov e d etails and
statement ar e corr ect; that all th e pro ducts w er e produced in
CHINA ----------------------------------------
(Country)
and that th ey comply with th e origin requir em ents sp ec巾edfor
e Rules of Origin for th e ACFTA for th e
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13.回Issu ed Retroactiv ely
口Mov em ent Certificat e
0 Exh心lion
口Thir dParty Invoicing
12. C ertification
It is her eby c�f control carried out, that th e
d eclara矗．
飞从
II I IIIIII II Ill Ill I 11111111111 11111 2351:3:::，1:):)2 ：：＇
Guangzho u, China ,JAN. 10,2023
－ － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － － －
Place and dat e, signatur e and stamp of c ertifying authority
235180000146443
FE P1-MICOGRESS BY GROSETTO (XY) Unglazed polished 4x20 FT
FE P2-MICOGRESS BY GROSETTO (XY) Unglazed polished 4x20 FT
