1．Goods consigned from(Exporter's business name，address，country)

Reference No．

GENERALIZED SYSTEM OF PREFERENCES

CERTIFICATE OF ORIGIN

(Combined declaration and certificate)

FORM A

issued in THE PEOPLE'S REPUBLIC 0F CHINA

(country)

See Notes Overleaf

 2．Goods consigned to(Consignee's name，address，country)

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

4．For offieial use

 5．Item number

 6．  Marks and numbers of pack-ages

7．Number and

 kind of pack-

ages；description

 of goods

 8．Origin erite-rion(see notes overleaf)

9．Gross weight or other quanti-

ty

10．Number and

date of invoices

 11．Certification

  It is hereby certified，on the basis of control carried out，that the declaration by the exporter is correct．

Place and date，signature and stamp of certifying authority

 12．Declaration by the exporter

  The undersigned hereby declares that the above details and statements are correct；that all the goods were produced in

CHINA

(country)

and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for goods exported to

(importingcountry)

Place and date，signature of authorized signatory