根據中國—哥斯達黎加自由貿易委員會第一次會議的決定，《中華人民共和國政府和哥斯達黎加共和國政府自由貿易協定》項下優惠原產地證書第2欄、第5欄、第6欄、第7欄、第12欄等欄目填制的背頁說明作了調整。現就執行上述決定的有關事宜公告如下：

　　一、自2012年10月14日起至2013年10月14日為過渡期。在過渡期內，進口貨物的收貨人或其代理人可以向海關提交由出口方簽證機構簽發的《中華人民共和國海關〈中華人民共和國政府和哥斯達黎加共和國政府自由貿易協定〉項下進出口貨物原產地管理辦法》(海關總署令第202號)所附格式的原產地證書，或者本公告附件所列格式的證書(以下簡稱“新證書”)。

　　二、自2013年10月15日起，進口貨物的收貨人或其代理人應當向海關提交出口方簽證機構簽發的新證書。

　　特此公告。

　　附件：調整格式后的原產地證書

　　海關總署

　　2012年10月11日

　　附件

　　Certificate of Origin

　　1. Exporter’s name, address, country:

　　Certificate No.:

　　CERTIFICATE OF ORIGIN

　　for China-Costa Rica Free Trade Agreement

　　Issued in

　　(see Overleaf Instruction)

　　2. Producer’s name and address, if known:

　　3. Importer’s name, address, country:

　　For Official Use Only:

　　4. Means of transport and route (as far as known)

　　Departure Date:

　　Vessel /Flight/Train/Vehicle No.:

　　Port of loading:

　　Port of discharge: 5. Remarks:

　　6. Item

　　number

　　(Max. 20) 7. Marks and Numbers on packages 8. Number and kind of packages; Description of goods 9. HS code

　　(6 digit code) 10. Origin

　　criterion 11. Gross weight or other quantity (e.g. Quantity Unit, liters, m3.) 12. Number, date of invoice

　　and Invoiced value

　　13. Declaration by the exporter

　　The undersigned hereby declares that the above stated information is correct, and that all the goods are produced in

　　(Country)

　　and that they comply with the origin requirements specified in the Free Trade Agreement for the goods exported to

　　(Importing country)

　　Place, date and signature of authorized person

　　14. Certification

　　On the basis of the carried out control, it is hereby certified that the information herein is correct and that the described goods comply with the origin requirements of the China -Costa Rica Free Trade Agreement.

　　Place and date , signature and stamp of the Authorized Body

　　Tel: Fax:

　　Address:

　　Overleaf Instruction

　　The English version of the Certificate of Origin shall be used and such Certificate shall be completed in that same language, in accordance with the overleaf instructions established herein.

　　Box 1: State the full legal name, address of the exporter in China or Costa Rica.

　　Box 2: State the full legal name, address (including country) of the producer. If more than one producer’s good is included in the certificate, list the additional producers, including name, address (including country). If the exporter or the producer wish the information to be confidential, state “Available to the competent authority or authorized body upon request”. If the producer and the exporter are the same, please complete the box with “SAME”. If the producer is unknown, state "UNKNOWN".

　　Box 3: State the full legal name, address of the importer in China or Costa Rica.

　　Box 4: Complete the means of transport and route and specify the departure date, transport vehicle No., port of loading and discharge, as far as known.

　　Box 5: Customer’s Order Number, Letter of Credit Number, among others, may be included. If the invoice is issued by a non-Party operator, information such as name and country of the operator issuing the invoice shall be indicated herein.

　　Box 6: State the item number, and item number shall not exceed 20. If the box’s space is not enough, additional pages, with the same form as the first page could be attached. Any additional page will have the phrase “page of ” noted, and the boxes 6 to 14 will be completed with the corresponding information.

　　Box 7: State the shipping marks and numbers on packages, when such marks and numbers exist, otherwise shall state “NO MARKS AND NUMBERS(N/M)”.

　　Box 8: Number and kind of packages 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 9: For each good described in Box 8, identify the HS tariff classification to 6 digit code.

　　Box 10: For each good described in Box 8, state which criterion is applicable, according to the following instructions. The rules of origin are contained in Chapter 4 (Rules of Origin and Related Operational Procedures) and Annex 3 (Product Specific Rules of Origin).

　　Origin Criterion Insert in Box 10

　　The good is “wholly obtained” in the territory of one or both Parties, as referred to in Article 22 (Wholly Obtained Goods). WO

　　The good is produced entirely in the territory of one or both Parties, exclusively from materials whose origin conforms to the provisions of Chapter 4 (Rules of Origin and Related Operational Procedures). WP

　　The good is produced in the territory of one or both Parties, using non-originating materials that comply with the Product Specific Rules and other applicable provisions of Chapter 4 (Rules of Origin and Related Operational Procedures). PSR

　　Box 11: State gross weight in kilos or other units of measurement for each good described in Box 8. Other units of measurement e.g. volume or number of items which would indicate exact quantities may be used when customary.

　　Box 12: Register the invoice number, date of invoice and the total invoiced value. In cases where invoices are issued by a non-Party operator, information such as the invoice number and invoice value shall be indicated herein.

　　Box 13: The box must be completed, signed and dated by the exporter. Insert the place (including the country where the goods are produced and imported), date and signature of authorized person.

　　Box 14: The box must be completed, signed, dated and stamped by the authorized person of the authorized body. The telephone number, fax and address of the authorized body should be given.

　　原產地證書(中文翻譯供參考)

　　1.出口商的名稱、地址、國家：

　　證書編號：

　　中國-哥斯達黎加自由貿易協定

　　原產地證書

　　簽發國 ____________

　　(填制方法詳見背頁說明)

　　2.生產商的名稱、地址，在已知情況下：

　　3.進口商的名稱、地址、國家：

　　僅供官方使用：

　　4.運輸方式及路線(就所知而言)

　　離港日期：

　　船舶/飛機/火車/車輛編號：

　　裝貨口岸：

　　到貨口岸： 5.備注：

　　6.項目號(最多20項) 7.嘜頭及包裝號

　　8.包裝數量及種類;商品描述 9.HS編碼(6位數編碼)

　　10.原產地標準 11.毛重或其它計量單位(如數量、升、立方米等) 12.發票號碼、開發票日期及發票價格

　　13.出口商申明

　　下列簽字人證明上述資料及聲明正確無誤，所有貨物產自

　　(國家)

　　且符合自由貿易協定原產地規則的相關規定。

　　該貨物出口至

　　(進口國)

　　地點、日期及授權人簽名 14.證明

　　根據所實施的監管，茲證明上述信息正確無誤，且所述貨物符合《中國-哥斯達黎加自由貿易協定》的原產地要求。

　　地點、日期 、簽名及授權機構印章

　　電話： 傳真：

　　地址：

　　背頁說明

　　原產地證書為英文版，且應當按照證書的背頁說明用英文填具。

　　第1欄：詳細填寫中國或哥斯達黎加的出口商依法登記的名稱、地址。

　　第2欄：詳細填寫生產商依法登記的名稱、地址(包括國家)。如果證書包含一家以上生產商的商品，應詳細列出其他生產商依法登記的名稱、地址(包括國家)。如果出口商或生產商希望對信息予以保密，填寫“應要求提供給主管機構或授權機構”。如果生產商和出口商相同，應填寫“同上”。如果不知道生產商，填寫“不知道”。

　　第3欄：詳細填寫中國或哥斯達黎加的進口商(收貨人)依法登記的名稱、地址。

　　第4欄：應據所知填寫運輸方式及路線，詳細說明離港日期、運輸工具編號、裝貨口岸和卸貨口岸。

　　第5欄：可以填寫顧客訂貨單號碼，信用證號碼等其他信息。如果發票是由非締約方的經營者開具的，則開具發票的該非締約方經營者的信息，如名稱、國家等，應在此欄注明。

　　第6欄：填寫項目號，項目號不得超過20項。當一頁原產地證書填制不下時，可以附頁填制，附頁格式應該和第一頁相同。所有附頁應注明“第 頁/ 共 頁”，且第6欄至第14欄應按有關要求填制。

　　第7欄：應填寫嘜頭及包裝號。如果沒有嘜頭及包裝號，應填寫“沒有嘜頭及包裝號”。

　　第8欄：詳細列明包裝數量及種類。詳列每種貨物的貨品名稱，以便于海關關員查驗時加以識別。貨品名稱應與發票及《協調制度》上的商品描述相符。如果是散裝貨，應注明“散裝”。在商品描述末尾加上“***”(三顆星)或“\”(結束斜線符號)。

　　第9欄：對應第8欄中的每種貨物填寫《協調制度》六位數稅則歸類編碼。

　　第10欄：若第8欄中的貨物符合原產地規則，出口商必須按照下表所示方式申明貨物享受優惠待遇所依據的原產地標準。原產地標準在第四章(原產地規則及相關操作程序)和附件3(產品特定規則)中予以明確：

　　原產地標準 填入第10欄

　　該貨物是根據第二十二條(完全獲得貨物)的相關規定，在締約一方或雙方境內完全獲得或生產; WO

　　該貨物是在締約一方或雙方境內，完全由符合第四章(原產地規則及相關操作程序)規定的原產材料生產的; WP

　　該貨物是在締約一方或雙方境內，使用符合第四章(原產地規則及相關操作程序)所規定的產品特定原產地規則及其他要求的非原產材料生產的。 PSR

　　第11欄：對第8欄中的每種貨物應填寫毛重(用“千克”衡量)或用其他計量單位衡量的數量。可依照慣例，采用其他計量單位(例如，體積、件數等)來精確地反映數量。

　　第12欄：應填寫發票號碼、發票日期及總的發票價格。如果發票是由非締約方的經營者開具的，則在此注明非締約方經營者開具發票的發票號碼、及發票價格。

　　第13欄：本欄目必須由出口商填寫、簽字并填寫日期。應包括貨物的生產國和進口國，以及授權簽字人的簽名。

　　第14欄：本欄必須由授權機構的授權人員填寫、簽名、填寫簽證日期并蓋章，并應注明授權機構的電話、傳真和地址。