1.Exporter'sbusinessname,address,country 4.ReferenceNo.

:___________________________Page:______/_______

MALAYSIACHILE FreeTradeAgreement CertificateofOrigin

(MCFTAFORM)
Issuedin________________________________________ (Country) (SeeOverleafNotes) ForOfficialUse PreferentialTreatmentGivenunderMCFTA PreferentialTreatmentNotGivenunderMCFTA(please statereason(s)) . SignatureofAuthorisedSignatoryoftheImportingCountry 5. 3.Meansoftransportandroute(asfarasknown) IssuedRetroactively Departuredate NonPartyInvoicing Duplicate Vessel'sname/Aircraftetc. Exhibition ___________________________________ PortofDischarge NameofthePlaceofExhibition (*)Insert()intheappropriatebox. 11.Number 8.Numberandtypeofpackages,descriptionofgoods(includingHScode) 9.Origin 10.Gross 6.Item 7.Marksand anddateof criterion weightor number numbersof invoices quantity packages 12.Declarationbytheexporter: 13.Certification I,theundersigned,declarethattheabovedetailsandstatementsaretrueand Itisherebycertified,onthebasisofcontrolcarriedout,thatthedeclarationby accurate,andthegood(s)describedabovemeetthecondition(s)requiredfor theexporteriscorrect. theissuanceofthiscertificate. PlaceandDate ................................................................................................................................. Placeanddate,signatureandstampof Signature: CompetentAuthority OVERLEAFNOTES

2.Consignee'sname,address,country

Forthepurposeofclaimingpreferentialtarifftreatment,thisformmustbecompletedlegiblyandfilledbytheexporter.Allitemsoftheform mustbecompletedintheEnglishlanguage. Ifthespaceofthisformisinsufficienttospecifythenecessaryparticularsforidentifyingthegoodsandotherrelatedinformation,theexporter mayprovidetheinformationusinganadditionalCertificateofOrigin. Box1: Box2: Box3: Box4: Box5: IftheCertificateofOriginisissuedRetroactively,pleasetick()theIssuedRetroactivelybox IncasewhereinvoicesareissuedbyanonParty,pleasetick()theNonPartyinvoicingbox IncasewheretheCertificateofOriginisaduplicateoftheoriginalinaccordancewithRule8,pleasetick()theDuplicatebox IncaseswherethegoodsaresentfromtheexportingPartyforexhibitioninathirdcountryinaccordancewithRule15,pleasetick ()theExhibitionboxandindicatethenameoftheplaceoftheexhibition. Box6: Box7: Box8: Providetheitemnumber. Providethemarksandnumberofpackages. Providethenumberandtypeofpackages,HStariffclassificationcodeanddescriptionofeachgoodsconsigned.Please indicateThe HStariffclassificationcodeatthesixdigitlevel. ThedescriptionofthegoodsonaCertificateofOriginshallbesubstantiallyidenticaltothedescriptionontheinvoiceand,ifpossible tothedescriptionundertheHScodeforthegoods. Box9: Forthegoodsthatmeettheorigincriterion,theexportermustindicatetheorigincriterionmetinthemannershowninthefollowing table: Criterion(InsertinBox9) DescriptionofCriterion A B(QVC40%orCTH) ThegoodsiswhollyobtainedorproducedintheterritoryofaPartyasdefinedinRule3. ThegoodsisproducedintheterritoryofaParty,usingnonoriginatingmaterialsthatconformto qualifyingvaluecontentorachangeintariffheadingasdefinedinRule4and5,respectively. ThegoodssatisfiestheproductspecificrulesasspecifiedinAppendixB. Thegoodsthatdoesnotundergoachangeintariffclassificationshallbeconsideredasoriginatingifthe valueofallnonoriginatingmaterialsusedinitsproductionthatdonotundergotherequiredchangein tariffclassificationdoesnotexceed10%oftheFOBvalueofthegoodandthegoodsmeetsallother applicablecriteriasetforthinthisChapter4(RulesofOrigin)forqualifyingasoriginatinggoods. ThegoodswhichsatisfiestheorigincriteriaunderRule2whichisusedinprocessingorproductionin theterritoryoftheotherPartyasmaterialforfinishedgoods,shallbedeemedasamaterialoriginating intheterritoryofthelatterPartywheretheworkingorprocessingofthefinishedgoodshastaken place. Statethefullname,addressandcountryoftheexporter. Statethefullname,addressandcountryoftheconsignee. Providethedeparturedate,thenameofvessel/aircraftandthenameoftheportofdischarge,asfarasknown. StatethecountrywheretheCertificateofOriginisissued.

C(PSR) DMI(DeMinimis)

ACU(Accumulation)

Box10: Box11: Indicatethequantityorgrossweightforeachgoods. Indicate theinvoice number(s) and date(s) for each goods.The invoiceis the one issued for theimportationof the goods intothe importingParty. IftheinvoiceisissuedbyapersondifferentfromtheexportertowhomtheCertificateofOriginisissuedandthepersonwhoissued theinvoiceislocatedinanonParty,pleaseindicatethenumberanddateofthenonPartyinvoice. IncaseswheretheinvoicenumberissuedinanonPartyatthetimeofissuanceoftheCertificateofOriginisnotknown,Box11isto, beleftblank. Box12: Box13: ThisBoxmustbecomplete,signanddatebytheexporter.TheDateisthedatewhentheCertificateofOriginisappliedfor. ThisBoxmustbecompleted,dated,signedandstampedbytheCompetentAuthorityoftheexportingParty.