ORIGINAL

1. Products consigned from (Exporter's business name, Reference No. 1853 – VN -CN
address, country)
CHANGSHA KANGMIN TRADING CO., LTD ASEAN-CHINA FREE TRADE AREA
PREFERENTIAL TARIFF
No. 139, Wanjiali Middle Road, Dongtundu Street, CERTIFICATE OF ORIGIN
Furong District, Changsha City, China (Combined Declaration and Certificate)
2. Products consigned to (Consignee's name, address, country)
FORM E
NAM VINH PHAT CO.,LTD
06/Đx 02-Th,Group 7,Tan Hoa Hamlet, Tan Vinh CHINA
Issued in _________
(Country)
Hiep Commune, Tan Uyen Town, Binh Duong
See Overleaf Notes
3.PROVINCE, VIETNAM
Means of transport and route (as far as known) 4. For Official Use
Preferential Treatment Given
BY SEA FROM HO CHI MINH, VN
Departure date ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯

12 NOV, 2023 Preferential Treatment Not Given (Please

Vessel's name/Aircraft etc. state reason/s)
NYK DIANA 093N ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
Port of Discharge
NANSHA, CHINA ……….………………………………..……..………………………………
Signature of Authorised Signatory of the Importing Party

5. Item 6. Marks and 7. Number and type of packages, description of 8. Origin criteria 9. Gross weight or 10. Number,
number numbers on products (including quantity where appropriate (see Overleaf net weight or other date of Invoices
packages and HS number in six digit code) Notes) quantity, and value
(FOB) only when
RVC criterion is
applied

1 EAN-8 2 PALLETS
CIGARS CONTAINING TOBACCO 88% 722,00 KGS
HS CODE: 24021000 USD HUQG1566
7.200,00 02 NOV,
USD 7.200,00 2023

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above details and It is hereby certified, on the basis of control carried out, that
statement are correct; that all the products were produced in the declaration by the exporter is correct.

CHINA
……………………………………………………………………………………..
(Country)
and that they comply with the origin requirements specified
for these products in the Rules of Origin for the ACFTA for the
products exported to

VIETNAM
……………………………………………………………………………………..
(Importing Country)

HO CHI MINH, 17 NOV, 2023

…………………………………………………………………………………….. CHANGSHA, 17 NOV, 2023
Place and date, signature of authorised signatory

13. £ Issued Retroactively £ Exhibition ……………………………………………………………………………………

£ Movement Certificate £ Third Party Invoicing Place and date, signature and stamp of certifying authority

£ Accumulation £ Partial Cumulation

OVERLEAF NOTES
1. Parties which accept this form for the purpose of preferential treatment under the ASEAN-China Free Trade Area (ACFTA):

BRUNEI DARUSSALAM CAMBODIA CHINA

INDONESIA LAOS MALAYSIA
MYANMAR PHILIPPINES SINGAPORE
THAILAND VIETNAM

2. CONDITIONS: The main conditions for admission to the preferential treatment under the ACFTA are that products sent to any Parties listed
above:

(i) must fall within a description of products eligible for concessions in the country of destination;
(ii) must comply with all relevant provisions of Annex 1 (Rules of Origin) of the Protocol to Amend the Framework Agreement on
Comprehensive Economic Co-operation and Certain Agreements thereunder between the Association of Southeast Asian Nations
(ASEAN) and the People’s Republic of China (ACFTA Upgrading Protocol).

3. ORIGIN CRITERIA: For each good described in Box 7 of this form, the origin criteria met should be indicated in Box 8, in the manner shown
in the following table:

Circumstances of production or manufacture in the first country

Insert in Box 8
named in Box 11 of this form
(a) Goods wholly produced or obtained satisfying
subparagraph (a) of Article 2 of Annex 1 of the ACFTA WO
Upgrading Protocol
(b) Goods produced in a Party exclusively from originating
materials from one or more of the Parties satisfying
PE
subparagraph (b) of Article 2 of Annex 1 of the ACFTA
Upgrading Protocol
(c) Goods produced from non-originating materials in a Party,
satisfying paragraph 1 of Article 4 of Annex 1 of the ACFTA
Upgrading Protocol
Actual percentage of ACFTA value
- Regional Value Content
content, example “40%”
- Change in Tariff Classification at the four-digit level CTH
(d) Goods satisfying the Product Specific Rules (PSR) in
PSR
Attachment B of Annex 1 of the ACFTA Upgrading Protocol

4. EACH ARTICLE MUST QUALIFY: It should be noted that all the products in a consignment must qualify separately in their own right. This
is of particular relevance when similar articles of different sizes or spare parts are sent.

5. DESCRIPTION OF PRODUCTS: The description of products in Box 7 must be sufficiently detailed to enable the products to be identified
by the Customs Officers examining them.

6. The Harmonised System number of the importing party in Box 7 (six digit code) shall be determined according to the International Convention
on the Harmonized Commodity Description and Coding System and subsequent amendments thereto.

7. The term “Exporter” in Box 1 and 11 may include the manufacturer or the producer. In the case of Movement Certificate (MC), the term
“Exporter” also includes the exporter in the intermediate Party. For China, a Chinese manufacturer can apply for a Certificate of Origin (Form
E) in the case where the manufacturer needs to authorise other agencies to export on its behalf. In this case, the manufacturer can make
the declaration indicated in Box 11 and shall state the name and address of the exporter in Box 7.

8. FOR OFFICIAL USE: The Customs Authority of the importing Party must indicate (√) in the relevant boxes in column 4 whether or not
preferential treatment is accorded.

9. MOVEMENT CERTIFICATE: In cases of Movement Certificate, in accordance with Rule 12 of Attachment A of the Rules of Origin of the
ACFTA Upgrading Protocol (Operational Certification Procedures): (i) “Movement Certificate” in Box 13 should be ticked (√); (ii) the indicated
value in Box 9 shall be the invoice value of the products exported from the intermediate Party. The indicated value in Box 9 is only required
when the RVC criterion is applied; (iii) The name of the original Issuing Authorities of the Party, date of the issuance and the reference
number of the original Certificate of Origin (Form E) to be indicated in Box 7.

10. THIRD PARTY INVOICING: In cases where invoices are issued by a third country, “the Third Party Invoicing” in Box 13 shall be ticked (√).
The invoice number shall be indicated in Box 10. Information such as name and country of the company issuing the invoice shall be indicated
in Box 7.

11. EXHIBITIONS: In cases where products are sent from the exporting Party for exhibition in another Party and sold during or after the exhibition
for importation into a Party, in accordance with Rule 22 of Attachment A of the Rules of Origin for the ACFTA, the “Exhibitions” in Box 13
should be ticked (√) and the name and address of the exhibition indicated in Box 2.

12. ISSUED RETROACTIVELY: In exceptional cases, due to involuntary errors or omissions or other valid causes, the Certificate of Origin
(Form E) may be issued retroactively in accordance with Rule 11 of Attachment A of the Rules of Origin for the ACFTA. The “Issued
Retroactively” in Box 13 shall be ticked (√) electronically or typewritten together with other information in the Certificate of Origin (Form E).
In cases where the “Issued Retroactively” in Box 13 cannot be ticked electronically or typewritten, the Certificate of Origin (Form E) shall be
stamped with the words “ISSUED RETROACTIVELY”.