ORIG:NAL

l Exporteris name and addressI

cerincate
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CERTIFICATE OF ORIG:N
2 Producers nalme and address if kno、 ぃ
′n: Forr71 for China‐ Peru FTA
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lssued in
(See OVetteaf nstrucJon)
3 0onslgnee's name and addressi

4. Means of transport and route (as far as known): For Official Use C)nlv:

Departure Date:

Vessel/FIightiTrain/Vehicle No. :

Port o[ loading: 5 Remarks

Port of discharge:

6. ltem 7. Number and kind of packages; description 8. HS code 9. Origin 10. Gross weight, 11. Numberand 12. Invoiced
number of goods (Six digit criterion quantity (Quantity date of invoice value
(Max 20) code) Unit) or other
measures (liters, m3,etc. )

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l3.Declaration by the exporter: 14. Certification:

On the basis of control carried out, it is hereby ce(ified that
The undersigned hereby declares that the above details and statement the information herein is correct and that the goods described
are correct, that all the goods were produced in comply with the origin requirements specified in the China-Peru FTA.

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Place and date, signature of authorized signatory Place and date, signature and stamp of authorized body

190138267