Certificate of Origin

Goods Originating in a Least Developed Country

(Instructions attached)

1. Exporter’sname, Address and Country / CERTIFICATE NO.
Page
CERTIFICATE OF ORIGIN
Goods Originating in a Least Developed Country
Issued in ______
( country )
2. Importer’s Name and Address in Taiwan
3.Means of Transport and Route (if known)（including shipped on board, vessel/flight no. , port of loading）
4.Marks and Number of Packages
5. HS Code / 6. Description of Goods / 7.Preference Criterion / 8.
Weight / Quantity / 9.Number and Date of Invoices
10.As the exporter, I hereby declare that the above details and statements are correct, namely：
  1. all the goods were produced in ______（name of country）; and
  2. the goods comply with the requirements specified in Chapter 3（Rules of Origin for Least-Developed Countries）of the Regulations Governing the Determination of Country of Origin of an Imported Goods, which is stipulated by the Ministry of Finance, Taiwan, R.O.C..

Applicant’s BusinessAccount Number
Applicant’s Name and Address
Signature or Stamp of Exporter
Date (dd/mm/yyyy) / Certification
It is hereby certified that all the goods were produced in ______（exporting country）and that they comply with the origin requirements of Taiwan.
Authorized Signature

Instructions for Completion of a Certificate of Origin for

Goods Originating in a Least Developed Country (LDC)

1.Countries for which a Certificate of Origin is required for the purpose of obtaining LDC preferential tariff treatments:

Afghanistan Guinea Samoa

Angola Guinea-Bissau Sao Tome and Principe

Bangladesh Haiti Senegal

Benin Kiribati Sierra Leone

Bhutan Lao People's Democratic Republic Burkina Faso Lesotho Solomon Islands

Burundi Liberia Somalia

Cambodia Madagascar Sudan

Cape Verde Malawi Timor Leste

Central African Republic Maldives Togo

Chad Mali Tuvalu

Comoros Mauritania Uganda

Democratic Republic of the Congo (formerly Zaire)

Djibouti Mozambique United Republic of Tanzania

Equatorial Guinea Myanmar Vanuatu

Eritrea Nepal Yemen

Ethiopia Niger Zambia

Gambia Rwanda

2.To qualify for LDC preferential tariff treatments, products must be shipped directly from the country of exportation to Taiwan, or shipped through a third country for the purpose of transit or temporary storage, provided that the said products did not undergo operations other than unloading or reloading in the country of transit.

3.For the purpose of obtaining LDC preferential tariff treatments, the certificate of origin must be completed legibly and in full by the exporter andbe submitted to Customs at the time the declaration is made.

4.There should be no alteration made to the certificate. The certificate is rendered invalid in the case that there is any alteration.

Field 1：State the name, address, and country of the manufacturer or exporter of the goods. The manufacturer or exporter must be located in the Least Developed Country (LDC) in which the goods are being certified. Do not identify a trading house, freight forwarder, or export broker, etc.

Field 2：State the name and address of the importer in Taiwan.

Field 3：Indicate the shipping details, as far as is known at the time when the Certificate of the Origin is completed.

Field 4：If the goods are crated or otherwise packaged, indicate the quantity of packages or crates. Also indicate any marks on the crates that may be cross-referenced from the Certificate of Origin to the Bill of Lading.

Field 5：Provide the Harmonized System subheading number for each item of goods.

Field 6：Provide a full description of each item of goods. Indicate model numbers, styles, serial numbers, or any other relevant description. It is in the exporter’s interest to give as full a description as possible.

Field 7：Preference Criteria

A：Enter the letter “Y” for items of goods that were wholly obtained in the Least Developed Country.

B：Enter the letter “Y50﹪” for the items of goods that were produced in the LDC and where there are two or more countries involved in the production of the goods, and the production process conducted by that least-developed country in which the goods were finished has added value to the goods by a ratio of no less than 50%.

Field 8：Indicate the weight and quantity for the goods described in Field 6.

Field 9：State the date(s) and the invoice number(s) for the goods described in Field 6.

Field 10：This field is to be completed by the exporter of the goods in the LDC in which the goods were finished in the form they were imported into Taiwan.

The individual completing the Certificate of Origin on behalf of the company seeking to export the goods must be knowledgeable regarding the origin of the goods and have access to production information, should verification be requested. This field is the exporter’s declaration that the Certificate of Origin is accurate and that the goods meet the LDC rules of origin as specified in Chapter 3 of Regulations Governing the Determination of Country of Origin of an Imported Goods, which is stipulated, by the Ministry of Finance, Taiwan, Republic of China.

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