■ 자유무역협정의 이행을 위한 관세법의 특례에 관한 법률 시행규칙 [별지 제13호서식]
아세안회원국과의 협정에 따른 원산지증명서의 서식(을지)
Original(Duplicate/Triplicate) (Additional Page) Reference No.
5. Item number	6. Marks and numbers on packages	7. Number and type of packages, description of goods(including quantity where appropriate and HS number of the importing country)	8. Origin Criterion (See Notes overleaf)	9. Gross weight or other quantity and Value (FOB only when RVC criterion is used)	10. Number and date of Invoices
11. Declaration by the exporter The undersigned hereby declares that the above details and statement are correct; that all goods were produced in ......................................... (Country) and that they comply with the origin requirements specified for these goods in the KOREA-ASEAN Free Trade Area Preferential Tariff for the goods exported to ...................................... (Importing Country) ...................................... Place and date, signature of authorised signatory			12. 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
13. □ Third Country Invoicing □ Exhibition □ Back-to-Back CO
Page _ of _ 210mm×297mm[백상지 80g/㎡(재활용품)]