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
2010064883OVERLEAF 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