Original “Products consigned from (Exporte’s business name, address, country) sbncheeshiseeteet “CRONE EEE 2. Products consigned to (Consignee’s name, address, country) THe. & ) Reference No. gor satnrest¥ 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 Overleat Notes 3m 6 of transport and route (98 faras known) Departure date Vessels name /Aircrattete, “HTH Pot of Discharge 4. For Official Use G Preferential Tratment Not Given (Please state reason/s) Signature of Authorised Signatory ofthe Importing Party S.item [6 Marks and |7. Number and type of packages, description 9.Gross weight or net | 10. Number, Number] numbers on | of products (including quantity wh wolghter othe quansiy| date of Packag: ‘appropriate and HS number in six digit code) ‘and value (FOB) only" | Involoas when RVC orton & | apphed ‘and that thoy comply withthe argin requirements spocitiog for these products in the Rules of Origin forthe ACFTA for the 4) INDONESIA Hangzhou, China, JAN. 25,2021 norised signs Signature 8 1 tesued Retroactively 1 Exhibition DI Movement Certificate 0 Thira Part Invoicing 12. Certification ool AGATA PafightbS Schina, JM, 25,2021 Place and date, signature and stamp of certilying authority 19410474395