Certificate of Origin
Certificate No.:
1. Exporters name, address, country:
HORTIFRUT CHILE S.A.
EDIFICION PIRAMIDE NORTE
CERTIFICATE OF ORIGIN
AVDA. DEL CONDOR 600 PISO 4
HUECHURABA - SANTIAGO CHILE.
Form F for China-Chile FTA
2. Producers name and address, if known:
SAME
CHILE
Issued in
(see Instruction overleaf)
3. Consignees name, address, country:
5. For Official Use Only
SHANGHAI OHENG IMPORT & EXPORT CO., LTD.
Preferential Tariff Treatment Given Under _______
4F OF BUILDING 1. NO.1688 YONGNAM ROAD
Preferential Treatment Not Given (Please state reasons)
(PUXING HWY) FENGXIAN DISTRICT
SHANGHAI, 201112, CHINA
4. Means of transport and route (as far as known)
Signature of Authorized Signatory of the Importing Country
Departure Date 01/19/2014
Vessel /Flight/Train/Vehicle No. 057-21632811
6. Remarks
Port of loading SANTIAGO, CHILE
Port of discharge SHANGHAI - CHINA
7. Item
8. Marks
number
10. HS code
11. Origin
12. Gross weight,
and
(Six digit
criterion
quantity (Quantity date of
(Max.
numbers
code)
20)
1.-
9. Number and kind of packages; description of goods
13. Number,
Unit) or other
invoice
on
measures (liters,
and invoiced
packages
m3, etc)
value
742 TRAYS CONTAINING FRESH BLUEBERRIES ***
0810.40
1.673 GROSS INVOICE
WEIGHT
200332
01/19/201
4USD
15953.00
C&F
14. Declaration by the exporter
15. Certification
The undersigned hereby declares that the above details and It is hereby certified, on the basis of control carried out, that the declaration of the
statement are correct, that all the goods were produced in
exporter is correct.
CHILE
(Country)
and that they comply with the origin requirements specified in the
FTA for the goods exported to
Place and date1, signature and stamp of certifying authority
CHINA
Certifying authority
Importing country)
Tel:
Fax:
SANTIAGO DE CHLE, 01/19/2014
ADDRESS:
Place and date, signature of authorized signatory
Overleaf Instruction
Box 1:
State the full legal name, address (including country) of the exporter.
Box 2:
State the full legal name, address (including country) of the producer. If more than one producers good is included in the certificate, list the
additional producers, including name, address (including country). If the exporter or the producer wishes the information to be confidential, it
is acceptable to state Available to the competent governmental authority upon request. If the producer and the exporter are the same, please
complete field with SAME. If the producer is unknown, it is acceptable to state "UNKNOWN".
Box 3:
State the full legal name, address (including country) of the consignee.
Box 4:
Complete the means of transport and route and specify the departure date, transport vehicle No., port of loading and discharge.
Box 5:
The customs authorities of the importing country must indicate () in the relevant boxes whether or not preferential tariff treatment is
accorded.
Box 6:
Customers Order Number, Letter of Credit Number, and etc. may be included if required. If the invoice is issued by a non-Party operator, the
name, address of the producer in the originating Party shall be stated herein.
Box 7:
State the item number, and item number should not exceed 20.
Box 8:
State the shipping marks and numbers on the packages.
Box 9:
Number and kind of package shall be specified. Provide a full description of each good. The description should be sufficiently detailed to
enable the products to be identified by the Customs Officers examining them and relate it to the invoice description and to the HS description
of the good. If goods are not packed, state in bulk. When the description of the goods is finished, add *** (three stars) or \ (finishing
slash).
Box 10:
For each good described in Box 9, identify the HS tariff classification to six digits.
Box 11:
If the goods qualify under the Rules of Origin, the exporter must indicate in Box 11 of this form the origin criteria on the basis of which he
claims that his goods qualify for preferential tariff treatment, in the manner shown in the following table:
The origin criteria on the basis of which the exporter claims that his goods qualify for
Insert in Box 11
preferential tariff treatment
Goods wholly obtained
Box 12:
General rule as 40% regional value content
RVC
Products specific rules
PSR
Gross weight in Kilos should be shown here. Other units of measurement e.g. volume or number of items which would indicate exact
quantities may be used when customary.
Box 13:
Invoice number, date of invoices and invoiced value should be shown here.
Box 14:
The field must be completed, signed and dated by the exporter. Insert the place, date of signature.
A Certificate of Origin under China-Chile Free Trade Agreement shall be valid for one year from the date of issue in the exporting country.
Box 15:
The field must be completed, signed, dated and stamped by the authorized person of the certifying authority. The telephone number, fax and
address of the certifying authority shall be given.
