1.Exporter's name andaddre5s coutry: Certificate No.: 2.Prodhucer'sname andaddress,coumtry: CERTFICATE0F 0RIGIN Fomm for China-KoreaFTA 3.Consigneesname andaddress country： Issuedin (see Orerleat Iustruction) 4.Means of transport and route （as far as 5.Remarks known): Departure Date: VesselFlight Train/Vehicle No.. Port ofloading Port ofdischarge 6.Ttem 9.HS code 10.Ogin 7.Marksand 8.Number 11.G05s 12.Number Numbers on Iq amnd kindof (Six-digit weight quantity iterion faaep PIE code) (MVax 20) packages packages (Ouantity Unit) descrip tion of invoice orother Foode measures Qliters, F3.ete.j 13.Declration by theexporter: 14.Cextification The undersigned hereby declares that the abore On the basis of control caried out,it is hereby certified details and statement are correct that all the that the information herein is correct and that the goods goods ware produeed in described comply with the origin requirements specified in the China-Korea FTA （Country） and thatt they rxcomply ，with th： onigin Plare and date signature and stamp ofauthonized body requirements specified in the FTA for the goods expartedto (Importing country) Place ad l date， signature pf athorized signatory

Overleaf Instuiction Certificate No: SerialmumberofCatificate ofOnigin assigned by the aulorized body Box1: VcyO eaneenernaoteoneayo Cnmoo dupe sappe e me em es Bax2: tBTTSnneeoD spooieocepoiderppoCrmnou Dlurpncer ssarnpe pure atteir eiett arats oneprodhucer are inchuledinthecerbficate listthe addifionalproducers inchuding theirfullegal name andadiress including countiy) Ifthe exporteror he producer wishes tomaintain this intamation as confidential itis acreptable to state AVAILABLEUPONREQUEST Irthe prodhcerandtheexporter arethesame,pleasecomplete fieldwith “SAME Box3: Stalethe fulllegalnanic and addrcss (including country ofthc consigreercsidant in citherKorca Bax4 Complete the means oftrnspcrtarnd rcute and specify the departure date transport velicle No orChina part ofloading and port ofdischarge Box5: Icase wheteagoodisinvoicedbyanon-Partycperator,the folllegalname coumtry ofthe nan-Party operator shall be indicated inthis box Incase otissuamce of certificates etrcartively should bearthewords“ISSUEDRETROACTIVELY andin case ofacertifiedtrue ccpy should bearthe words CERTIFIED TRUE COPY of theoniginal Certificatc ofOnigin mumber_ dated Bax6: stafethe itemmumber and the rmber ofitems shouldnot exceed 20. Box 7: Stafethe shippingmarksand mumberson packagcs whcnsuch marks and mubcrs cxist ifthe shipping marks are imagesOrsymbols othierthan leiter ormumericalmumber shall state TMAGE ORSYMBOL (IS) otherwise shll state NO MARKS AND NUMBERS(NAM Box8: Thc mumbcr andhindofpackagcs shall bespecified Providc afull desciptionofeachi good The Oficers examining them andrelate themtotheirvolce descrip ticnand tothe HS descriptionofthe desciption shauld be suficienuy detailed toenable the goods tobeidentified by the Customs good.Ifthe goods arenot packed state INBULK Bax9: Foreachgood descnibedinBox 8.idenifytheHS taniffdlassificationto six-digit Box10: The expcrtermust indicate inBox 10the cnigin criteria an the basis of which heclaimsthat the goods qualify forpreterentialtanff treatment inthe mamershowninthe fiollowing table: Origin Cniteria InsertinBox 10 Thc goodis whollyobtainedarproduced cntirclyinaPaty assct outand delined in Article 3.4(Gools Wholly Obrained or Produred ariequired Wo so nAnnex 3-A (Product Specific Rules of Onign) The goodisproduccd cntirelyinaPaty cxchusivcly frommatcrials whose origin confoms toChapter 3 (Rules of Origin andOrigin WP Implementation Procedhrres) Thre goodisprodhiced ina Paty using ron-originating materials that confommtoachangeintarifciassificationaregicmlvalue content a process requrement or otier requirements specitied mAnnex3-A PSR Product Specific Ruks of Ongin The goodis subjecto Article 3.3 (Treatment of Certaingoods) OP Box11: Gross weightinKilosshouldbe shown here.Other umits ofmersirementeg vohmme ornuber ofitems winich would indicate exact quant tesmy be used when austomary Bax12: Irvoiccmimbcrand dateofinvoiccshouldbe shown hcrc Incac whaca goodisinvoiced bya non-Paity operatdr amndthe mumber ani date ofthe commeicial invoiceis unknown thenunber and dateofthe cniginalcommercialinvoice issuedin the exparting Party shal be indicatedinthis box Bax 13: Thisbox shallbe completed sigued and dated by thecxporter Box14: This box shallbe completed signed dated and stampedby the aurhorized person oftheauthanized boay.