《中华人民共和国政府和新加坡共和国政府自由贸易协定》中国原产地证书格式（样本）.doc

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中国原产地证书格式（样本）
1.货物启运自 (出口商的名称、地址、国家)

证书号码：
中国-新加坡自由贸易区
优惠税率
原产地证书
(申请表格和证书合一)
签发国______________
（填制方法详见证书背面说明）
2. 货物运输至 (收货人的名称、地址、国家)
3．运输方式及路线（就所知而言）
离港日期
船舶/飞机等的名称
卸货口岸

4. 供官方使用
可享受中国-新加坡自贸区优惠关税待遇
不能享受优惠待遇（须说明理由）：
.............................
进口国官方机构的授权人签名
5. 项目号码
6.唛头及包装号码
7. 包装数量及种类、商品描述(包括数量以及进口国的HS编码)
8. 原产地标准（详见背页说明）

9.毛重或其它计量单位及FOB价格
10.发票号码及日期

11．由出口商申报
兹申明上述填报资料及说明正确无误，所有货物产自

（XX国家）
且符合中国-新加坡自贸区原产地规则的相关规定，该货物出口至

（XX进口国）

地点、日期及签名
12．证明
根据实际监管，兹证明出口商的申报正确。

地点、日期、签名及签证机构印章

背页说明
第一栏：应填写中国出口商的法人全称、地址（包括国家）。
第二栏：应填写新加坡收货人的法人全称、地址（包括国家）。
第三栏：应填写运输方式、路线，并详细说明离港日期、运输工具的编号及卸货口岸。

第四栏：不论是否给予优惠关税待遇，进口方海关必须在相应栏目标注(√ )。
第五栏：应填写项目号码。
第六栏：应填写唛头及包装号码。
第七栏：应详细列明包装数量及种类。详细列明每种货物的商品描述，以便于海关关员查验时识别。商品描述应与发票所述及《协调制度》的商品描述相符。如果是散装货，应注明“散装”。在商品描述末尾加上“***”（三颗星）或“＼”（斜杠结束号）。第七栏的每种货物应填写《协调制度》六位数编码。
第八栏：若货物符合原产地规则，出口商必须按照下列表格中规定的格式，在第八栏中标明其货物享受优惠关税待遇所依据的原产地标准：
出口商申明其货物享受优惠关税待遇所依据的原产地标准
填入第八栏
（1）中国-新加坡自贸区原产地规则规定在出口方完全获得的产品
“P”
（2）区域价值成分≥40%的产品
“RVC”
（3）符合产品特定原产地规则的产品
“PSR”
第九栏：毛重应填写“千克”。可依惯例填写其他计量单位，例如体积、数量等，以准确反
映其数量。FOB价格应在此栏中注明。
第十栏：应填写发票号码及开发票的日期。
第十一栏：本栏必须由出口商填写、签名并填写日期。应填写签名的地点及日期。
第十二栏：本栏必须由签证机构的授权人员填写、签名、填写签证日期并盖章。

China’s Certificate of Origin：
Original (Copies)

Reference No.

1. Goods consigned from (Exporter's business name,
CHINA-SINGAPORE FREE TRADE AREA
address, country)

PREFERENTIAL TARIFF

CERTIFICATE OF ORIGIN

(Combined Declaration and Certificate)

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

country)

Issued in ______________

(Country)

See Notes Overleaf

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

4. For Official Use

Departure date

Preferential Treatment Given Under CHINA- SINGAPORE

Free Trade Area Preferential Tariff

Vessel's name/Aircraft etc.

Preferential Treatment Not Given (Please

state reason/s)

Port of Discharge

....................................................

Signature of Authorised Signatory of the Importing

Country

5. Item
6. Marks and
7. Number and type of

8. Origin criterion
9. Gross
10. Number and
number
numbers on
packages, description of
(see Notes
weight or
date of

packages
goods (including quantity
overleaf)
other quantity
invoices

where appropriate and HS

and value

number of the importing

(FOB)

country)

11. Declaration by the exporter

12. Certification

The undersigned hereby declares that the above
It is hereby certified, on the basis of control
details and statement are correct; that all the goods
carried out, that the declaration by the
were produced in

exporter is correct.

.............................................................

(Country)

and that they comply with the origin requirements

specified for these goods in the China-Singapore

Free Trade Area Preferential Tariff for the goods

exported to

.........

(Importing Country)

.............................................................
................................................................................
Place and date, signature of

Place and date, signature and stamp of
authorised signatory
certifying authority

OVERLEAF INSTRUCTION
Box 1: State the full legal name, address (including country) of the exporter in China.
Box 2: State the full legal name, address (including country) of the consignee in Singapore.
Box 3: Complete the means of transport and route and specify the departure date, transport vehicle, port of discharge.
Box 4: The customs authorities of the importing country must indicate (√ ) in the relevant boxes whether or not preferential tariff treatment is accorded.
Box 5: State the item number.
Box 6: State the shipping marks and numbers on the packages.
Box 7: Number and type of packages shall be specified. Provide a full description of each good. The description should be sufficiently detailed to enable the products to be identified by the Customs Officers examining them and relate it to the invoice description and to the HS description of the good. If goods are not packed, state “in bulk”. When the description of the goods is finished, add “***” (three stars) or “ \ ” (finishing slash). For each good described in Box 7, identify the HS tariff classification to six digits.
Box 8: If the goods qualify under the Rules of Origin, the exporter must indicate in Box 8 of this form the origin criteria on the basis of which he claims that his goods qualify for preferential tariff treatment, in the manner shown in the following table:

The origin criteria on the basis of which the exporter claims that his goods qualify for preferential tariff treatment
Insert in Box 8
(a) Products wholly obtained in the exporting Party as defined in China-Singapore FTA Rules of Origin
“P”
(b) Region value content ≧ 40%
“RVC”
(c) Products satisfied the Products Specific Rules
“PSR”

Box 9: Gross weight in Kilos should be shown here. Other units of measurement e.g. volume or number of items which would indicate exact quantities may be used when customary; the FOB value shall be indicated here.
Box 10: Invoice number and date of invoices should be shown here.
Box 11: The field must be completed, signed and dated by the exporter. Insert the place, date of signature.
Box 12: The field must be completed, signed, dated and stamped by the authorised person of the certifying authority.

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