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ee (ict se Sy ro BTLING 9 WOME TRH COTE, SLANE, rena cane ‘2Producer's name and adress, known: WVATLABLE. TO THE AUTHORIZED BODY UPON REQUEST '3. Consignea's name and address: LORENZD CORPORATION 4. 20518386003 LERIDA NRO. 216 DPTO. 901 URB. MAYORKZG0 26RA TAPA LIMA ~ ATE. ~ PERU hs Corneate No. RZSMADHEABLSO003 CERTIFICATE OF ORIGIN Form for China-Peru FTA ‘the Peopli aie # Republic of China (cee verte instruction) {SSUED RETROSPECTIVELY 4. Means of tanspot and route (a ar a¢ known: Departure Dato-FEB. 21, 2023 VesseUFighrainVehice No.ZHT HANG 868 ¥, 230220 For Official Use Only Verification:origin, custoxs. gov.cn 18.Decaration by he exporter ‘Tho underignes hereby decare thal he above deta and statement sar correct, hat al te goods were produced in om py iGanini REM ve oe Sees PERU in ‘iit Aeris Pace and date, sgn of authorizes eonatony Port of toading: CAOMING, CHINA ‘5, Remarks: Pot of 8cheeeCALLAO, PERU eas Than |. Niber ard nd opp: econ] 6 into orga JO. Same waa Napa | TE ae umber | of goods (Sic | enaion |quantty(Qvanity | éatectinvaee | valve fie a tora ear for) it ‘TWENTY FIVE (25) PALLETS OF POLISHED poor.21 tap” ‘L440SQUARE_ K23002A |POB: USD me jerent rea. : ai ozs J ‘THIRTEEN (13) PALLETS OF GLAZED TILE 007.21 fwp* rosa > |rve c@ pauuets ce cage rue foro fee | teres oo. sas le FIFTEEN (15) CARTONS OF GRIFERIA p481.80 ‘METE Goce ane at oe S seopteces 74. Owe ‘On the basis of contol cares out, is hereby cette that Place and date, signature and stamp of authrz04 ody 2010064883 OVERLEAF INSTRUCTION Cortiicate No.: Serial number of Certificate of Origin assigned by the authorized body. Box 1: State the full legal name and address (including country) of the exporter. Box 2: State the full lagal name and address (including country) of the producer. If goods from more than one producer are included in the certificate, list the additional producers, including their full legal name and address (Including country). Ifthe exporter or the producer wishes to maintain this information as confi

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