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ORIGINAL

Reference No. VN-CN 25/08/0151800

1.Products consigned from (Exporter's business name,

address, country)

THIEN THUY HA GIANG ONE MEMBER LIMITED LIABILITY

COMPANY

ASEAN-CHINA FREE TRADE AREA

GIANG NAM VILLAGE, THANH THUY COMMUNE, TUYEN QUANG

PROVINCE,

PREFERENTIAL TARIFF

CERTIFICATE OF ORIGIN

(Combined Declaration and Certificate)

VIET NAM

2.Products consigned to (Consignee's name, address, country)

RESIDENTS OF TIANBAO IN YUNNAN PROVINCE CHINA

FORM E

TIANBAO, YUNNAN

CHINA

Issued inVIETNAM

(Country)

See Overleaf Notes

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

4.For Official Use

Preferential Treatment Given

BY TRUCK

Departure date

31/12/2025

¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯

Preferential Treatment Not Given (Please

state reason/s)

Vessel's name/ Aircraft etc.

BY TRUCK

¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯

Port of Discharge

TIANBAO (CHINA)

……….………………………………..……..………………………………

Signature of Authorised Signatory of the Importing Party

10.Number,

date of Invoices

7. Number and type of packages, description of

products (including quantity where appropriate

and HS number in six digit code)

8.Origin criteria

(see Overleaf

Notes)

9.Gross weight or

net weight orother

quantity,and value

(FOB) only when

RVC criterion is

applied

5.Item

number

6.Marks and

numbers on

packages

BAGS

PEANUTS

780 BAGS

39,000.00KILOGRAM

LNHG12-00012

DATE:31/12/2025

HS CODE : 12024200

11.Declaration by the exporter

12.Certification

The undersigned hereby declares that the above details and

statement are correct;that all the products were produced in

It is hereby certified, on the basis of control carried out, that

the declaration by the exporter is correct.

VIETNAM

……………………………………………………………………………………..

(Country)

and that they comply with the origin requirements specified

for these products in the Rules of Origin for the ACFTA for

the products exported to

CHINA

……………………………………………………………………………………..

(Importing Country)

TUYEN QUANG, 31/12/2025

……………………………………………………………………………………..

Place and date, signature of authorised signatory

LANG SON, 31/12/2025

……………………………………………………………………………………

Place and date, signature and stamp of certifying authority

13.

Issued Retroactively

MovementCertificate

Exhibition

Third Party Invoicing

Page 1 / 1

OVERLEAF NOTES

1. Parties which accept this form for the purpose of preferential treatment under the ASEAN-China Free Trade Area (ACFTA):

BRUNEI DARUSSALAM

INDONESIA

CAMBODIA

LAOS

PHILIPPINES

VIETNAM

CHINA

MALAYSIA

SINGAPORE

MYANMAR

THAILAND

2. CONDITIONS: The main conditions for admission to the preferential treatment under the ACFTA are that products sent to any Parties

listed above:

must fall within a description of products eligible for concessions in the country of destination;

must comply with all relevant provisions of Annex 1 (Rules of Origin) of the Protocol to Amend the Framework Agreement on

Comprehensive Economic Co-operation and Certain Agreements thereunder between the Association of Southeast Asian Nations

(ASEAN) and the People’s Republic of China (ACFTA Upgrading Protocol).

3. ORIGIN CRITERIA: For each good described in Box 7 of this form, the origin criteria met should be indicated in Box 8, in the manner

shown in the following table:

Circumstances of production or manufacture in the first country

Insert in Box 8

named in Box 11 of this form

(a) Goods wholly produced or obtained satisfying

subparagraph (a) of Article 2 of Annex 1 of the ACFTA

Upgrading Protocol

(b) Goods produced in a Party exclusively from originating

materials from one or more of the Parties satisfying

subparagraph (b) of Article 2 of Annex 1 of the ACFTA

Upgrading Protocol

satisfying paragraph 1 of Article 4 of Annex 1 of the ACFTA

Upgrading Protocol

Actual percentage of ACFTA value

- Regional Value Content

content, example “40%”

- Change in Tariff Classification at the four-digit level

CTH

PSR

(d)

Goods satisfying the Product Specific Rules (PSR) in

Attachment B of Annex 1 of the ACFTA Upgrading Protocol

4. EACH ARTICLE MUST QUALIFY: It should be noted that all the products in a consignment must qualify separately in their own right. This

is of particular relevance when similar articles of different sizes or spare parts are sent.

5. DESCRIPTION OF PRODUCTS: The description of products in Box 7 must be sufficiently detailed to enable the products to be identified

by the Customs Officers examining them.

6. The Harmonised System number of the importing party in Box 7 (six digit code) shall be determined according to the International

Convention on the Harmonized Commodity Description and Coding System and subsequent amendments thereto.

7. The term “Exporter” in Box 1 and 11 may include the manufacturer or the producer. In the case of Movement Certificate (MC), the term

“Exporter” also includes the exporter in the intermediate Party. For China, a Chinese manufacturer can apply for a Certificate of Origin

(Form E) in the case where the manufacturer needs to authorise other agencies to export on its behalf. In this case, the manufacturer can

make the declaration indicated in Box 11 and shall state the name and address of the exporter in Box 7.

8. FOR OFFICIAL USE: The Customs Authority of the importing Party must indicate (√) in the relevant boxes in column 4 whether or not

preferential treatment is accorded.

9. MOVEMENT CERTIFICATE: In cases of Movement Certificate, in accordance with Rule 12 of Attachment A of the Rules of Origin of the

ACFTA Upgrading Protocol (Operational Certification Procedures): (i) “Movement Certificate” in Box 13 should be ticked (√); (ii) the

indicated value in Box 9 shall be the invoice value of the products exported from the intermediate Party. The indicated value in Box 9 is

only required when the RVC criterion is applied; (iii) The name of the original Issuing Authorities of the Party, date of the issuance and the

reference number of the original Certificate of Origin (Form E) to be indicated in Box 7.

10. THIRD PARTY INVOICING: In cases where invoices are issued by a third country, “the Third Party Invoicing” in Box 13 shall be ticked (√).

The invoice number shall be indicated in Box 10. Information such as name and country of the company issuing the invoice shall be

indicated in Box 7.

11. EXHIBITIONS: In cases where products are sent from the exporting Party for exhibition in another Party and sold during or after the

exhibition for importation into a Party, in accordance with Rule 22 of Attachment A of the Rules of Origin for the ACFTA, the “Exhibitions” in

Box 13 should be ticked (√) and the name and address of the exhibition indicated in Box 2.

12. ISSUED RETROACTIVELY: In exceptional cases, due to involuntary errors or omissions or other valid causes, the Certificate of Origin

(Form E) may be issued retroactively in accordance with Rule 11 of Attachment A of the Rules of Origin for the ACFTA. The “Issued

Retroactively” in Box 13 shall be ticked (√) electronically or typewritten together with other information in the Certificate of Origin (Form E).

In cases where the “Issued Retroactively” in Box 13 cannot be ticked electronically or typewritten, the Certificate of Origin (Form E) shall

be stamped with the words “ISSUED RETROACTIVELY”.