根据中国—哥斯达黎加自由贸易委员会第一次会议的决定，《中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定》项下优惠原产地证书第2栏、第5栏、第6栏、第7栏、第12栏等栏目填制的背页说明作了调整。现就上述决定的有关事宜公告如下：

　　一、自2012年10月14日起至2013年10月14日为过渡期。在过渡期内，工伤赔偿。进口货物的收货人或其人可以向海关提交由出口方签证机构签发的《中华人民共和国海关〈中华人民共和国政府和哥斯达黎加共和国政府自由贸易协定〉项下进出口货物原产地管理办法》(海关总署令第202号)所附格式的原产地证书，或者本公告附件所列格式的证书(以下简称“新证书”)。

　　二、自2013年10月15日起，进口货物的收货人或其代理人应当向海关提交出口方签证机构签发的新证书。工伤赔偿。

　　特此公告。

　　附件：调整格式后的原产地证书

　　海关总署

　　2012年10月11日

　　附件

　　Certificate of Origin

　　1. Exporter’s name, address, country:

　　Certificate No.:

　　CERTIFICATE OF ORIGIN

　　for China-Costa Rica Free Trade Agreement

　　Issued in

　　(see Overleaf Instruction)

　　2. Producer’s name and address, if known:

　　3. Importer’s name, address, country:

　　For Official Use Only:

　　4. Means of transport and route (as far as known)

　　Departure Date:

　　Vessel /Flight/Train/Vehicle No.:

　　Port of loading:

　　Port of discharge: 5. Remarks:

　　6. Item

　　number

　　(Max. 20) 7. Marks and Numbers on packages 8. Number and kind of packages; Description of goods 9. HS code

　　(6 digit code) 10. Origin

　　criterion 11. Gross weight or other quantity (e.g. Quantity Unit, liters, m3.) 12. Number, date of invoice

　　and Invoiced value

　　13. Declaration by the exporter

　　The undersigned hereby declares that the above stated information is correct, and that all the goods are produced in

　　(Country)

　　and that they comply with the origin requirements specified in the Free Trade Agreement for the goods exported to

　　(Importing country)

　　Place, date and signature of authorized person

　　14. Certification

　　On the basis of the carried out control, it is hereby certified that the information herein is correct and that the described goods comply with the origin requirements of the China -Costa Rica Free Trade Agreement.

　　Place and date , signature and stamp of the Authorized Body

　　Tel: Fax:

　　Address:

　　Overleaf Instruction

　　The English version of the Certificate of Origin shall be used and such Certificate shall be completed in that same language, in accordance with the overleaf instructions established herein.

　　Box 1: State the full legal name, address of the exporter in China or Costa Rica.

　　Box 2: State the full legal name, address (including country) of the producer. If more than one producer’s good is included in the certificate, list the additional producers, including name, address (including country). If the exporter or the producer wish the information to be confidential, state “Available to the competent authority or authorized body upon request”. If the producer and the exporter are the same, please complete the box with “SAME”. If the producer is unknown, state "UNKNOWN".

　　Box 3: State the full legal name, address of the importer in China or Costa Rica.