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2024年3月16日发(作者：)
中国-东盟自贸区优惠关税原产地证（Form E）
1. Goods consigned from (Exporter’s business name,
Reference No.
(Combined Declaration and Certificate)
address, country)
（填写出口人合法的全称、地址和国名。
该出口人必须是在商检局登记的公司。）
FORM E
Issued in The People’s Republic of China
(Country)
See Instruction Overleaf
2. Goods consigned
name,address,country)
to(Consignee’s official use
Preferential Treatment Given Under ASEAN-CHINA
Free Treade Area Preferential Tariff
Preferential Treatment Not Given(Please state reason/s)
…………………………………………………………
Signature of Authorised signatory of the importing Country
………………………………………………………………
3. Means of transport and route(as far as known)
Departure Date 走船时间???
Vessel’s name/Aircraft etc.船名船次???
Port of discharge: 目的港口，目的港（目的国）：
item
number
1
2
3
Signature of Authorised signatory of the importing Country
（无需填写：进口国海关在该栏注明根据协定是否给予优惠）
6. Marks and
num-
ber on
Packages
and type of
packages,description fo goods
(including quantity where appropriate
and HS number of the importing
Country)
criterion
(see notes
overleaf)
weight or
Other
Quantity
and value
(FOB)
and date of
invoices:发票号码/时
间
ation by the exporter
The undersigned hereby declares that the above
details and statements are correct, that all the goods
were produced in
……………………………………………………
icate
It is hereby certified on the basis of control carried out, that the
declaration by the exporter is correct.
(Country)
and that they comply with the origin requirements
（无需填写）
specified for these goods in the Asia–Pacific Trade
…………………………………………………
Agreement for goods exported to (无需填写)
Place and date, signature and Stamp of Certifying Authority
…………………………………………(Importing
Country)
………………………………………………………
………
Place and date, signature of authorized Signatory
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