发布部门: 海关总署
发布文号: 公告2012年第47号
根据中国—哥斯达黎加自由贸易委员会第一次会议的决定，《中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定》项下优惠原产地证书第2栏、第5栏、第6栏、第7栏、第12栏等栏目填制的背页说明作了调整。现就执行上述决定的有关事宜公告如下：
一、自2012年10月14日起至2013年10月14日为过渡期。在过渡期内，进口货物的收货人或其代理人可以向海关提交由出口方签证机构签发的《中华人民共和国海关〈中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定〉项下进出口货物原产地管理办法》（海关总署令第202号）所附格式的原产地证书，或者本公告附件所列格式的证书（以下简称“新证书”）。
二、自2013年10月15日起，进口货物的收货人或其代理人应当向海关提交出口方签证机构签发的新证书。
特此公告。
附件：调整格式后的原产地证书
海关总署
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.
原产地证书（中文翻译供参考）
1.出口商的名称、地址、国家：
证书编号：
中国-哥斯达黎加自由贸易协定
原产地证书
签发国 ____________
(填制方法详见背页说明)
2.生产商的名称、地址，在已知情况下：
3.进口商的名称、地址、国家：
仅供官方使用：
4.运输方式及路线（就所知而言）
离港日期：
船舶/飞机/火车/车辆编号：
装货口岸：
到货口岸： 5.备注：
6.项目号（最多20项） 7.唛头及包装号
8.包装数量及种类；商品描述 9.HS编码（6位数编码）
10.原产地标准 11.毛重或其它计量单位（如数量、升、立方米等） 12.发票号码、开发票日期及发票价格
13.出口商申明
下列签字人证明上述资料及声明正确无误，所有货物产自
（国家）
且符合自由贸易协定原产地规则的相关规定。
该货物出口至
（进口国）
地点、日期及授权人签名 14.证明
根据所实施的监管，兹证明上述信息正确无误，且所述货物符合《中国-哥斯达黎加自由贸易协定》的原产地要求。
地点、日期 、签名及授权机构印章
电话： 传真：
地址：
背页说明
原产地证书为英文版，且应当按照证书的背页说明用英文填具。
第1栏：详细填写中国或哥斯达黎加的出口商依法登记的名称、地址。
第2栏：详细填写生产商依法登记的名称、地址（包括国家）。如果证书包含一家以上生产商的商品，应详细列出其他生产商依法登记的名称、地址（包括国家）。如果出口商或生产商希望对信息予以保密，填写“应要求提供给主管机构或授权机构”。如果生产商和出口商相同，应填写“同上”。如果不知道生产商，填写“不知道”。
第3栏：详细填写中国或哥斯达黎加的进口商（收货人）依法登记的名称、地址。
第4栏：应据所知填写运输方式及路线，详细说明离港日期、运输工具编号、装货口岸和卸货口岸。
第5栏：可以填写顾客订货单号码，信用证号码等其他信息。如果发票是由非缔约方的经营者开具的，则开具发票的该非缔约方经营者的信息，如名称、国家等，应在此栏注明。
第6栏：填写项目号，项目号不得超过20项。当一页原产地证书填制不下时，可以附页填制，附页格式应该和第一页相同。所有附页应注明“第 页/ 共 页”，且第6栏至第14栏应按有关要求填制。
第7栏：应填写唛头及包装号。如果没有唛头及包装号，应填写“没有唛头及包装号”。
第8栏：详细列明包装数量及种类。详列每种货物的货品名称，以便于海关关员查验时加以识别。货品名称应与发票及《协调制度》上的商品描述相符。如果是散装货，应注明“散装”。在商品描述末尾加上“***”（三颗星）或“”（结束斜线符号）。
第9栏：对应第8栏中的每种货物填写《协调制度》六位数税则归类编码。
第10栏：若第8栏中的货物符合原产地规则，出口商必须按照下表所示方式申明货物享受优惠待遇所依据的原产地标准。原产地标准在第四章（原产地规则及相关操作程序）和附件3（产品特定规则）中予以明确：
原产地标准 填入第10栏
该货物是根据第二十二条（完全获得货物）的相关规定，在缔约一方或双方境内完全获得或生产； WO
该货物是在缔约一方或双方境内，完全由符合第四章（原产地规则及相关操作程序）规定的原产材料生产的； WP
该货物是在缔约一方或双方境内，使用符合第四章（原产地规则及相关操作程序）所规定的产品特定原产地规则及其他要求的非原产材料生产的。 PSR
第11栏：对第8栏中的每种货物应填写毛重（用“千克”衡量）或用其他计量单位衡量的数量。可依照惯例，采用其他计量单位（例如，体积、件数等）来精确地反映数量。
第12栏：应填写发票号码、发票日期及总的发票价格。如果发票是由非缔约方的经营者开具的，则在此注明非缔约方经营者开具发票的发票号码、及发票价格。
第13栏：本栏目必须由出口商填写、签字并填写日期。应包括货物的生产国和进口国，以及授权签字人的签名。
第14栏：本栏必须由授权机构的授权人员填写、签名、填写签证日期并盖章，并应注明授权机构的电话、传真和地址。
发布文号: 公告2012年第47号
根据中国—哥斯达黎加自由贸易委员会第一次会议的决定，《中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定》项下优惠原产地证书第2栏、第5栏、第6栏、第7栏、第12栏等栏目填制的背页说明作了调整。现就执行上述决定的有关事宜公告如下：
一、自2012年10月14日起至2013年10月14日为过渡期。在过渡期内，进口货物的收货人或其代理人可以向海关提交由出口方签证机构签发的《中华人民共和国海关〈中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定〉项下进出口货物原产地管理办法》（海关总署令第202号）所附格式的原产地证书，或者本公告附件所列格式的证书（以下简称“新证书”）。
二、自2013年10月15日起，进口货物的收货人或其代理人应当向海关提交出口方签证机构签发的新证书。
特此公告。
附件：调整格式后的原产地证书
海关总署
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.
原产地证书（中文翻译供参考）
1.出口商的名称、地址、国家：
证书编号：
中国-哥斯达黎加自由贸易协定
原产地证书
签发国 ____________
(填制方法详见背页说明)
2.生产商的名称、地址，在已知情况下：
3.进口商的名称、地址、国家：
仅供官方使用：
4.运输方式及路线（就所知而言）
离港日期：
船舶/飞机/火车/车辆编号：
装货口岸：
到货口岸： 5.备注：
6.项目号（最多20项） 7.唛头及包装号
8.包装数量及种类；商品描述 9.HS编码（6位数编码）
10.原产地标准 11.毛重或其它计量单位（如数量、升、立方米等） 12.发票号码、开发票日期及发票价格
13.出口商申明
下列签字人证明上述资料及声明正确无误，所有货物产自
（国家）
且符合自由贸易协定原产地规则的相关规定。
该货物出口至
（进口国）
地点、日期及授权人签名 14.证明
根据所实施的监管，兹证明上述信息正确无误，且所述货物符合《中国-哥斯达黎加自由贸易协定》的原产地要求。
地点、日期 、签名及授权机构印章
电话： 传真：
地址：
背页说明
原产地证书为英文版，且应当按照证书的背页说明用英文填具。
第1栏：详细填写中国或哥斯达黎加的出口商依法登记的名称、地址。
第2栏：详细填写生产商依法登记的名称、地址（包括国家）。如果证书包含一家以上生产商的商品，应详细列出其他生产商依法登记的名称、地址（包括国家）。如果出口商或生产商希望对信息予以保密，填写“应要求提供给主管机构或授权机构”。如果生产商和出口商相同，应填写“同上”。如果不知道生产商，填写“不知道”。
第3栏：详细填写中国或哥斯达黎加的进口商（收货人）依法登记的名称、地址。
第4栏：应据所知填写运输方式及路线，详细说明离港日期、运输工具编号、装货口岸和卸货口岸。
第5栏：可以填写顾客订货单号码，信用证号码等其他信息。如果发票是由非缔约方的经营者开具的，则开具发票的该非缔约方经营者的信息，如名称、国家等，应在此栏注明。
第6栏：填写项目号，项目号不得超过20项。当一页原产地证书填制不下时，可以附页填制，附页格式应该和第一页相同。所有附页应注明“第 页/ 共 页”，且第6栏至第14栏应按有关要求填制。
第7栏：应填写唛头及包装号。如果没有唛头及包装号，应填写“没有唛头及包装号”。
第8栏：详细列明包装数量及种类。详列每种货物的货品名称，以便于海关关员查验时加以识别。货品名称应与发票及《协调制度》上的商品描述相符。如果是散装货，应注明“散装”。在商品描述末尾加上“***”（三颗星）或“”（结束斜线符号）。
第9栏：对应第8栏中的每种货物填写《协调制度》六位数税则归类编码。
第10栏：若第8栏中的货物符合原产地规则，出口商必须按照下表所示方式申明货物享受优惠待遇所依据的原产地标准。原产地标准在第四章（原产地规则及相关操作程序）和附件3（产品特定规则）中予以明确：
原产地标准 填入第10栏
该货物是根据第二十二条（完全获得货物）的相关规定，在缔约一方或双方境内完全获得或生产； WO
该货物是在缔约一方或双方境内，完全由符合第四章（原产地规则及相关操作程序）规定的原产材料生产的； WP
该货物是在缔约一方或双方境内，使用符合第四章（原产地规则及相关操作程序）所规定的产品特定原产地规则及其他要求的非原产材料生产的。 PSR
第11栏：对第8栏中的每种货物应填写毛重（用“千克”衡量）或用其他计量单位衡量的数量。可依照惯例，采用其他计量单位（例如，体积、件数等）来精确地反映数量。
第12栏：应填写发票号码、发票日期及总的发票价格。如果发票是由非缔约方的经营者开具的，则在此注明非缔约方经营者开具发票的发票号码、及发票价格。
第13栏：本栏目必须由出口商填写、签字并填写日期。应包括货物的生产国和进口国，以及授权签字人的签名。
第14栏：本栏必须由授权机构的授权人员填写、签名、填写签证日期并盖章，并应注明授权机构的电话、传真和地址。
