Products consigned Wom (Exporters business name, address, = country) = NANYANG EXPLOSTON PROTECTION GROLP CO.,LTD. ‘22: NORTH ZHONGTING. ROAD, NANYANG, HENAN, Z GUNE '2: Producis consigned io (Consignes's name, address, country) LAME NGIHEN TECENIC CO-,_ LTD. 47/i8-AO-DOT STREET, BIN TRE DONG A WARD BING = TAN DIST. HO CHO MING CITY, VIETNAM. “Means of transport and route (as far as known) —Departuredaie DEE, 20,2015 ‘Vessets nama Arcrat etc, TMATTN BELARWY 15268 ~~ Port of Discharge HOCHTMING-CITY-PORT: SHUPEMNT FROH QINGEAD, CHT TO ‘ROGHTWINE PORT, VIETINW BY SEA. Reference No. fs 106050020016 ASEAN-CHINA FREE TRADE AREA PREFERENTIAL TARIFF CERTIFICATE OF ORIGIN (Combined Declaration and Certificate) FORM E Issued in_THE PEOPLE” S REPUBLIC OF CHINA (Country) See Overieaf Notes. 4. For Official Use cteariamemmieR eye Gi PreereiialTeatment Not Given (Please sta reasons) Sighatue of Auforised Signatory ofthe Imporing Party 7.Numbér and type of packages, ‘of products (including quantity where. appropriate and HS numberof the ‘importing Party) 9.Gross weight or |10: Number and ‘other quantity | ~ date of and value (FOB) Origin ertteria (Gee Overloat Notes) THREE () WOODEN CASES GLY. HS COPE: 8501.52 ‘PROTECTION GROUP CO.,LTD: HENAN PROVINCE, PR CHINA ee 3 PCS AC ELECTRIC MOTORS PACKED “IN MANDPACTURIR: NANYANG EXPLOSION 411. Declaration by the exparier ‘The undersigned hereby declares that the above detals and Statement are correct that all the products were produced in sats 12, Certification itis hereby certified, on the basis of contro! carried out, thatthe declaration by the exporter is correct.