原產地證書僅供官方使用：依照《依照《中國-哥斯達黎加自由貿易協定》簽發的原產地證書應當自出口方簽發之日起一年內有效。.背頁說明CertificateofOrigin1.Exporter’sname,address,country:CertificateNo.:CERTIFICATEOFORIGINFormforChina-CostaRicaFreeTradeAgreementIssuedin(seeOverleafInstruction)2.Producer’snameandaddress,ifknown:3.Importer’sname,address,country:ForOfficialUseOnly:4.Meansoftransportandroute(asfarasknown)DepartureDate:Vessel/Flight/Train/VehicleNo.:Portofloading:Portofdischarge:5.Remarks:6.Itemnumber(Max.20)7.MarksandNumbersonpackages8.Numberandkindofpackages;Descriptionofgoods9.HScode(6digitcode)10.Origincriterion11.Grossweightorotherquantity(e.g.QuantityUnit,liters,m3.)12.Number,dateofinvoiceandInvoicedvalue13.DeclarationbytheexporterTheundersignedherebydeclaresthattheabovestatedinformationiscorrect,andthatallthegoodsareproducedin(Country)andthattheycomplywiththeoriginrequirementsspecifiedintheFreeTradeAgreementforthegoodsexportedto（Importingcountry)Place,dateandsignatureofauthorizedperson14.CertificationOnthebasisofthecarriedoutcontrol,itisherebycertifiedthattheinformationhereiniscorrectandthatthedescribedgoodscomplywiththeoriginrequirementsoftheChina-CostaRicaFreeTradeAgreement.PlaceanddateACertificateofOriginissuedunderChina-CostaRicaFreeTradeAgreementshallbevalidforoneyearfromthedateofissuanceintheexportingcountry.,signatureandstampoftheAuthorACertificateofOriginissuedunderChina-CostaRicaFreeTradeAgreementshallbevalidforoneyearfromthedateofissuanceintheexportingcountry.Tel: Fax: Address: OverleafInstructionBox1: Statethefulllegalname,addressoftheexporterinChinaorCostaRicaBox2: Statethefulllegalname,address(includingcountry)oftheproducer.Ifmorethanoneproducer’sgoodisincludedinthecertificate,listtheadditionalproducers,includingname,address(includingcountry).Iftheexporterortheproducerwishtheinformationtobeconfidential,itisacceptabletostate“Availabletothecompetentauthorityorauthorizedbodyuponrequest”.Iftheproducerandtheexporterarethesame,pleasecompletetheboxBox3: Statethefulllegalname,addressoftheimporterinChinaorCostaRicaBox4: Completethemeansoftransportandrouteandspecifythedeparturedate,transportvehicleNo.,portofloadinganddischargeBox5: Customer’sOrderNumber,LetterofCreditNumber,amongothers,Box6: Statetheitemnumber,anditemnumbershouldnotexceed20.Box7: Statetheshippingmarksandnumbersonpackages,asapplicable.Box8: Numberandkindofpackagesshallbespecified.Provideafulldescriptionofeachgood.ThedescriptionshouldbesufficientlydetailedtoenabletheproductstobeidentifiedbytheCustomsOfficersexaminingthemandrelateittotheinvoicedescriptionandtotheHSdescriptionofthegood.Ifgoodsarenotpacked,state“inbulk”.Whenthedescriptionofthegoodsisfinished,add“***”(threestars)or“\”(finishingslash).Box9: ForeachgooddescribedinBox8,identifytheHStariffclassificationto6digitcode.Box10: ForeachgooddescribedinBox8,statewhichcriterionisapplicable,accordingtothefollowinginstructions.TherulesoforiginarecontainedinChapter4(RulesofOriginandRelatedOperationalProcedures)andAnnex3(ProductSpecificRulesofOrigin)OriginCriterionInsertinBoxThegoodis“whollyobtained”intheterritoryofoneorbothParties,asreferredtoinArticle22(WhollyObtainedGoods).WOThegoodisproducedentirelyintheterritoryofoneorbothParties,exclusivelyfrommaterialswhoseoriginconformstotheprovisionsofChapter4(RulesofOriginandRelatedOperationalProcedures).WPThegoodisproducedintheterritoryofoneorbothParties,usingnon-originatingmaterialsthatcomplywiththeProductSpecificRulesandotherapplicableprovisionsofChapter4(RulesofOriginandRelatedOperationalProcedures).PSRBox11: StategrossweightinkilosorotherunitsofmeasurementforeachgooddescribedinBox8.Box12: Registertheinvoicenumber,dateofinvoiceandtheinvoicedvalue,foreachgooddescribedinBox8Box13: Theboxmustbecompleted,signedanddatedbytheexporter.Inserttheplace(includingthecountrywherethegoodsareproduced