1.Exporter'sname,address,countryCertificateNo.:FORMEIssuedinThePeople'sRepublicofChina2.Consignee'sname,address,country:3.Meansoftransportandroute(asfarasknown)4.ForOfficialUseDepartureDatePreferentialTreatmentGivenUnderASEAN-CHINAVessel/Flight/Train/VehicleNo.PreferentialTreatmentNotGiven(Pleasestatereasons)PortofdischargeSignatureofAuthorizedSignatoryoftheimportingCounry5.Item6.Marksand7.Numberandtypeofpackages;description8.Origincriterionnumbernumbersonofgoods(includingquantitywhere(seeNotespackagesappropriateandHSNUMBERoftheoverleaf)importingCountry)11.Declarationbytheexporter12.CertificationItisherebycertified,onthebasisofcontrolcarriedout,thatTheundersignedherebydeclaresthattheabovedetailsandstatementthedeclarationoftheexporteriscorrect.arecorrect,thatallthegoodswereproducedinandthattheycomplywiththeoriginrequirementsspecifiedintheFTAforthegoodsexportedtoPlaceanddate,signatureofauthorizedsignatoryCHINA(Importingcountry)INDONESIA(Country)FreeTradeAreaPreferentialTariff9.Grossweight,orquantityandvalue(FOB)10.Number,dateofinvoice