5.1 原产地证申请书（Application for certificate of Origin)
一般原产地证明书/加工装配申请书
Application for Certificate of Origin/Processing Assembling
申请单位注册号： 证书号：
Registry No. of the Certificate No.
Applying Corporation
申请人郑重声明：
本人被正式授权代表本企业办理和签署本申请书。
本申请书及一般原产地证明书/加工装配证明书所列内容正确无误，如发现弄虚作假，冒充证书所列货物，擅改证书，本人愿按《中华人民共和国出口货物原产地规则》的有关规定接收处罚。现将有关情况申报如下：
1,the undersigned Applicant, hereby declare that I am the representative formally authorized by the said corporation to deal with and sign this Application and that the statement herein and that in the General Certificate of Origin or the Certificate of Processing Assembling are correct and of no mistake and I shall be sanctioned in accordance with the Regulations of the Origin for Exports of the People’s Republic of China if any fraud, passing off any goods as those listed in the certificate or any unauthorized modification of the certificate exists. The items reported as follows
企业名称
Name of Corp
发票号
Invoice No.
商品名称
Prescription
H.S.编码（六位数）
NO .of H.S
商品FOB总值（以美元计）
Value(FOB)US￥
最终目的地国/地区
Destination Country (District)
拟出运日期
Shipping Date
转口国（地区）
Transshipment Country(district)
贸易方式和企业性质（请在适用处划“√”）
Mode of Business Nature of Corp.
(Please follow the instructions with“√” )
一般贸易
Ordinary Business
三来一补
3 Processings & I Trade
其他贸易方式
Others
1.State-owned
Enterprise
2.Sino-foreign
Joint venture;
Sino-foreign
Co-op;
Wholly foreign-owned
1.State-owned
Enterprise
2.Sino-foreign
Joint venture;
Sino-foreign
Co-op;
Wholly foreign-owned
1.State-owned
Enterprise
2.Sino-foreign
Joint venture;
Sino-foreign
Co-op;
Wholly foreign-owned
包装数量或毛重或其他数量
________________________________________________________________________________________
证书种类（划“√”） 一般原产地证明书 加工装配证明书
Classification General Certificate Processing & Assembling
Of Certificate(Please of Origin Certificate
Follow the instruction
With“√”
________________________________________________________________________________________
( Component parts processing, component assembling, processing with customer’sdesigns;compensation trade)
现提交中国出口货物商业发票副本一份，一般原产地证明书/加工装配证明书一正三副，以及其他附件____份，请予审核签证。
Enclosed with one copy of the business invoice of Chinese exports, one original General Certificate of Origin/Processing & Assembling and three copies thereof,and other appendices,plase have a check before the certificate is issued.
申请单位盖章 申请人：（签名）
(for seal) Signature of Applicant:
电话：
Tel:
日期：____年____月____日
Date：____,________
5．2一般原产地证明
例1
1. Exporter (full name and address)
出口商（姓名、地址）
2.Consignee(full name,address,country)
收货人（姓名、地址、国家）
Certificate No.0503280
证明书编号：
CERTIFICATE OF ORING OF THE PEOPLE’S REPUBLIC OF CHINA
中华人民共和国原产地证明
3.Means of transport and route
运输方式和路线
4.Destination port
目的港
5.For certifying authority use only
核证当局专用栏
6.Marks and numbers of packages
包装标记和件数
7.Description of goods, number and kind of packages
货物名称、件数和包装种类
8.H.S.Code H.S
编码
9.Quantity or weight
数量或重量
10.Number and dete of invoices
发票编号和日期
11.Declaration by the exporter The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in China and that they with the Rules of Origin of the People’s Republic of Chins.
出口商声明
以下签名者特此声明上述细节及陈述均确凿无误；保证所有产品均为中国制造，且符合中华人民共和国原产地原则。
12.Certfication
It is hereby certified that the declaration by the exporter is correct.
证明
兹证明出口商的声明确凿无误。
Place and date, signature and stamp of authorized signatory
地址、日期以及业经授权的签署者的签名和印章
Place and date, signature and stamp of authorized signatory
地址、日期以及业经授权的签署者的签名和印章
