以下为中国通用的普惠证格式：
1．Goods consigned from (Exporter’s business name , address, country)
货物发自：（出口商公司名称、地址、国家）
Reference No. G. J930208编号：
GENERALIZED SYSTEM OF
PREFERENCES CERTIFICATE OF
ORIGIN
普惠证
(Combined declaration and certificate)
用作声明和证明
FORM A
格式1
Issued in __________
(country)
签发（国名）
See Notes overleaf
参见背面注释
2．Goods consigned to (Consignee’s name, address ,country)
货物运至：（收货人姓名、地址、国家）
3．Means of transport and route (as far as known)
FROM CHONGQING CHINA TO
WANNINXVEEN, HOLLAND VIA HONG KONG BY LAND-SEA
COMBINED TRANSPORTATION
运输工具和路线（就已知情况填写）：从中国重庆运至荷兰某地，途经香港，陆路和水路并用
4．For official use
供正式使用
5.Item 6. Marks and 7. Number 8. Origin 9. Gross 10. Number
Number numbers of and kind of criterion weight and date
商品编号 packages package; (see Notes or other of invoices
标记和件数 description overleaf) quantity
of goods 原产地标准 毛量或其他日期
包装编号和 数量
种类；货物
品名
1 N/M 20MT CITRIC ACID “P”20.32MT 960502
MONO-HYDRATE BP80
PACKED IN 25KGS MAY.3TH
NET PLASTIC WOVEN 1999.
BAGS EACH
20MT PACKED IN
800(EIGHT HUNDRED)
PLASTIC WOVEN BAGS.
11．Certification:
It is hereby certified, on the basis of control carried out ,that the declaration by the exporter is correct.
证明：
兹证明出口商的声明属实，符合现行管理标准规定。
CHONGQING,CHINA 中国重庆
MAY,14TH,1999.
1999年5月14日
12. Declaration by the exporter:
The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in HINA(country)and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for goods exported to HOLLAND .
(importing country)
出口商声明：
以下署名人在此声明上述申报各项无讹，所有商品都产于（中国），且符合普惠制所规定的出口（荷兰）产品的原产地要求。
CHONGQING, CHINA MAY, 12TH 1999
WANG MING
(Place and date, signature of authorized signatory)
（地址、日期以及授权签名人的签字）
Place and date, signature and stamp of certifying authority
（地址、日期，批准机关签字和印章）
