FORM E（REVISED）00

ORIGINAL 1.Goodsconsignedfrom(Exporter'sbusinessname,address,country)出口商，名称，地址，国家DongguanCityMaikekuIndustrialCO.,LTDADDRESS:JinxiangheIndustrialZone,No.1,ShaxiRoad,Shahukou,ChangpingTown,DongguanCity,GuangdongProvince,ChinaTEL:+86-0757-85599297 ReferenceNo.ASEAN-CHINAFREETRADEAREAPREFERENTIALTARIFFCERTIFICATEOFORIGIN(Combineddeclarationandcertificate)FORMEIssuedinTHEPEOPLE'SREPUBLICOFCHINA(Country)SeeNotesOverleaf 2.Goodsconsignedto(Consignee'sname,address,country)收货人名称/公司地址 SAN-VICTRADERS,INC.DUROSCOMPLEX,YATI,LILO-AN,CEBU,PHILIPPINES.TEL:63-32-4249379 3.Meansoftransportandroute(asfarasknown)运输方式出货日期 4.Forofficialuse口PreferentialTreatmentGivenUnderASEAN-CHINAFreeTradwAreaPreferentialTariff--------------------------------------------------------------------------------口PreferentialTreatmentNotGiven(Pleasestatereason/s)…...…………………………………………SignatureofAuthorisedSignatoryoftheimportcountry DepartureDateSEP.16,2015Vessel’sname/Aircraftetc.UNI-ACTIVE261EPortofdischargeCEBU,PHILIPPINES 5.ItemNumber项目编号 6.Marksandnumbersonpackages 7.Numberandtypeofpackages,descriptionofgoods(includingquantitywhereappropriateandHSnumberoftheimportingCountry)品名和箱数 8.Origincriterion(seeNotesoverleaf)原产地证的标准 9.Grossweightorotherquantityandvalue(FOB)毛重，数量和货值 10.Numberanddateofinvoices 唛头 发票号和日期 1 SAN-VIC ICECREAMMACHINETK-938THSCODE:8418699020TOTAL:(2)CTNSONLY.SHIPPED UNDER B/L No. 143586128956SHIPPEDBY:NINGBO HENGWEI IMPORT AND EXPORT CO.,LTD ADDRESS:7/F BUILDING TIANZHIHAI NO.48 DALIANG STREET,NINGBO,CHINATEL: 0086-579-82319117843420001SET 90% 310.00KGSUSD3840.20 20150708SEP1,2015 11.DeclarationbytheexporterTheundersignedherebydeclaresthattheabovedetailsandStatementarecorrect;thatallthegoodswereproducedinCHINA(Country)andthattheycomplywiththeoriginrequirementsspecifiedforthesegoodsintheASEAN-CHINAFreeTradeAreaPreferentialTariffforthegoodsexportedtoThailand(ImportingCountry)TianjinChinaJan.7,2012Placeanddate,signatureofauthorisedsignatory 12CertificationItisherebycertified,onthebasisofcontrolcarriedout,thatthedsclarationbytheexporteriscorrect.TianjinChinaJan.7,2012--------------------------------------------------------------------------Placeanddate,signatureandstampofcertifyingauthority