背页说明
第一栏：应填写中国出口商的法人全称、地址（包括国家）。
第二栏：应填写新加坡收货人的法人全称、地址（包括国家）。
第三栏：应填写运输方式、路线，并详细说明离港日期、运输工具的编号及卸货口岸。
第四栏：不论是否给予优惠关税待遇，进口方海关必须在相应栏目标注（√ ）。
第五栏：应填写项目号码。
第六栏：应填写唛头及包装号码。
第七栏：应详细列明包装数量及种类。详细列明每种货物的商品描述，以便于海关关员查验时识别。商品描述应与发票所述及《协调制度》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“＼”（斜杠结束号）。第七栏的每种货物应填写《协调制度》六位数编码。
第八栏：若货物符合原产地规则，出口商必须按照下列表格中规定的格式，在第八栏中标明其货物享受优惠关税待遇所依据的原产地标准：
出口商申明其货物享受优惠关税待遇所依据的原产地标准
| 填入第八栏
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（1） 中国-新加坡自贸区原产地规则规定在出口方完全获得的产品
| “P”
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（2） 区域价值成分≥40%的产品
| “RVC”
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（3） 符合产品特定原产地规则的产品
| “PSR”
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第九栏：毛重应填写“千克”。可依惯例填写其他计量单位，例如体积、数量等，以准确反
映其数量。FOB价格应在此栏中注明。
第十栏：应填写发票号码及开发票的日期。
第十一栏：本栏必须由出口商填写、签名并填写日期。应填写签名的地点及日期。
第十二栏：本栏必须由签证机构的授权人员填写、签名、填写签证日期并盖章。
China’s Certificate of Origin：
Original （Copies）
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| Reference No.
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1. Goods consigned from （Exporter's business name，
| CHINA-SINGAPORE FREE TRADE AREA
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address， country）
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| PREFERENTIAL TARIFF
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| CERTIFICATE OF ORIGIN
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| （Combined Declaration and Certificate）
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2. Goods consigned to （Consignee's name， address，
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country）
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| | | | Issued in ______________
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| | | | | （Country）
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| | | | | See Notes Overleaf
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3. Means of transport and route （as far as known）
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| 4. For Official Use
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Departure date
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| | Preferential Treatment Given Under CHINA- SINGAPORE
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| | | | Free Trade Area Preferential Tariff
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Vessel's name/Aircraft etc.
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| | Preferential Treatment Not Given （Please
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Port of Discharge
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| | Signature of Authorised Signatory of the Importing
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| | Country
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5. Item
| 6. Marks and
| 7. Number and type of
| | 8. Origin criterion
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number
| numbers on
| packages， description of
| （see Notes
| weight or
| date of
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| goods （including quantity
| overleaf）
| other quantity
| invoices
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| | where appropriate and HS
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| and value
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| | number of the importing
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| （FOB）
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| | country）
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11. Declaration by the exporter
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| 12. Certification
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The undersigned hereby declares that the above
| It is hereby certified， on the basis of control
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details and statement are correct； that all the goods
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were produced in
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（Country）
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and that they comply with the origin requirements
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specified for these goods in the China-Singapore
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Free Trade Area Preferential Tariff for the goods
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exported to
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（Importing Country）
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Place and date， signature of
| Place and date， signature and stamp of
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authorised signatory
| certifying authority
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