輸出伊朗貨品證明書(申請書)
Certificate of Exporting Goods to Iran (Application)
證號 Issue No.
核發日期 Issue Date 有效期限 Expiry Date
出口報單號碼:
Export declaration No.
.
* 申請人 (出口人) Applicant(
Exporter) 名稱
Name of Exporter
聯絡人
Name of Applicant 地址
Address
負責人
Name of Representative 電話 Telephone
統一編號 Business Registration No.
傳真 Fax 電子郵件 e-mail address
* 進口人 Importer
名稱
Name of Importer 電話 Telephone
地址 Address
* 買方 Buyer
名稱
Name of Buyer 電話 Telephone
地址 Address
運送人 Forwarder
名稱
Name of Forwarder
船名 vessel name
地址 Address 電話 Telephone
* 項 次 Item
*
貨品分類號列 CCC Code
*貨品明細 Specifications of Goods
*數量/單位 Quantity
*單價 Unit Price (USD)
*總價 Total Value (USD)
交易文件號碼/日期 Contract No./ Date of Contract
(yyyy/mm/dd) 貨品名稱及貨品型號
Model Number & Name
貨品規格、成分/貨品 用途
Specifications/Usage
第1 聯:國際貿易局留存聯(For BOFT’s files) 收件編號:
出口人聲明輸出貨品是否屬戰略性高科技貨品種類
*
確認貨品是否屬戰 略性高科技貨品輸 出管制清單
(請連結
Classification Search Tool#篩選)
Item Classification
□ 歐盟軍商兩用貨品及技術
出口管制清單(Community Regime for the Control of Exports of Dual Use Items and Technology)
□ 歐盟一般軍用貨品清單
(Common Military List of the European Union)
□ 輸往北韓及伊朗之敏感貨
品清單(Sensitive Commodities List ,SCL)
□ 非屬前述清單貨品
None of the above list of goods
*
確認交易對象是 否屬國際出口管
制實體名單(請連
結Restricted Parties Screening Tool篩選) Entity Classificaion
進口商 Importer
買方 Buyer
運送人 Forwarder
*
確認本項交易有無異 常情況(請連結紅色 警戒篩選
http://ekm92.trade.gov.
tw/BOFT/OpenFileSer vice?
file_id=870633410387 ee22efc2370d8a2aae1f
&context=83ee4cf785a d25a257533d1ac7c3b8 2f)
Red Flag Classification
□ 有 Yes
□ 無 NO
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
申請人(出口人)聲明:
上述內容均已據實填報,並已閱讀瞭解『經濟部國際貿易局核發輸出伊朗貨品證明書作業要點』內容及遵守『貿易
法』、『戰略性高科技貨品輸出入管理辦法』之規定,如有不實或有違法情事,願依貿易法第二十七條及第二十七條
之一規定接受刑罰及行政處罰
。
Applicant(Exporter) undertakes:
It is hereby certified that I have filled out this document in good faith and understand the “Operational Guidelines for Certificate of Exporting Goods to Iran issued by BOFT” and comply with the rules of the “Foreign Trade Act” and
“Regulations Governing Export and Import of Strategic High-Tech Commodities”. Any false statement willfully made in this document or occurrence of any violation is subject to criminal punishment and/or administrative sanction in accordance with the Article 27, 27-1 of the “Foreign Trade Act”
申請人 Name of Applicant 簽名 Signature
簽發單位聲明:
若因與伊朗外匯清算政策改變,或其他不可控制的外力因素,造成承辦清算銀行無法辦理外匯清算時,本證明書 不保證能透過臺伊外匯清算機制取得貨款。
Approving Agency declares :
Issuance of this confirmation form does not guarantee the completion of financial transactions when the Iran policy of a foreign exchange bank involved or other uncontrollable outside factors would not allow the applicant's bank to process the transactions.
簽發單位簽章 Approving Agency Signature
應檢附文件:
1.海關關章之出口報單證明聯。
2.交易文件、產品型錄、產品規格、成分/用途說明書。
Required Documents:
輸出伊朗貨品證明書
Certificate of Exporting Goods to Iran
證號 Issue No.
核發日期 Issue Date 有效期限 Expiry Date
出口報單號碼:
Export declaration No.
.
* 申請人 (出口人) Applicant(
Exporter) 名稱
Name of Exporter
聯絡人
Name of Applicant 地址
Address
負責人
Name of Representative 電話 Telephone
統一編號 Business Registration No.
傳真 Fax 電子郵件 e-mail address
* 進口人 Importer
名稱
Name of Importer 電話 Telephone
地址 Address
* 買方 Buyer
名稱
Name of Buyer 電話 Telephone
地址 Address
運送人 Forwarder
名稱
Name of Forwarder
船名 vessel name
地址 Address 電話 Telephone
* 項 次 Item
*
貨品分類號列 CCC Code
*貨品明細 Specifications of Goods
*數量/單位 Quantity
*單價 Unit Price (USD)
*總價 Total Value (USD)
交易文件號碼/日期 Contract No./ Date of Contract
(yyyy/mm/dd) 貨品名稱及貨品型號
Model Number & Name
貨品規格、成分/貨品 用途
Specifications/Usage
第2 聯:承辦銀行聯(For Bank’s files) 收件編號:
出口人聲明輸出貨品是否屬戰略性高科技貨品種類
*
確認貨品是否屬戰 略性高科技貨品輸 出管制清單
(請連結
Classification Search Tool#篩選)
Item Classification
□ 歐盟軍商兩用貨品及技術
出口管制清單(Community Regime for the Control of Exports of Dual Use Items and Technology)
□ 歐盟一般軍用貨品清單
(Common Military List of the European Union)
□ 輸往北韓及伊朗之敏感貨
品清單(Sensitive Commodities List ,SCL)
□ 非屬前述清單貨品
None of the above list of goods
*
確認交易對象是 否屬國際出口管
制實體名單(請連
結Restricted Parties Screening Tool篩選) Entity Classificaion
進口商 Importer
買方 Buyer
運送人 Forwarder
*
確認本項交易有無異 常情況(請連結紅色 警戒篩選
http://ekm92.trade.gov.
tw/BOFT/OpenFileSer vice?
file_id=870633410387 ee22efc2370d8a2aae1f
&context=83ee4cf785a d25a257533d1ac7c3b8 2f)
Red Flag Classification
□ 有 Yes
□ 無 NO
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
申請人(出口人)聲明:
上述內容均已據實填報,並已閱讀瞭解『經濟部國際貿易局核發輸出伊朗貨品證明書作業要點』內容及遵守『貿易
法』、『戰略性高科技貨品輸出入管理辦法』之規定,如有不實或有違法情事,願依貿易法第二十七條及第二十七條
之一規定接受刑罰及行政處罰
。
Applicant(Exporter) undertakes:
It is hereby certified that I have filled out this document in good faith and understand the “Operational Guidelines for Certificate of Exporting Goods to Iran issued by BOFT” and comply with the rules of the “Foreign Trade Act” and
“Regulations Governing Export and Import of Strategic High-Tech Commodities”. Any false statement willfully made in this document or occurrence of any violation is subject to criminal punishment and/or administrative sanction in accordance with the Article 27, 27-1 of the “Foreign Trade Act”
申請人 Name of Applicant 簽名 Signature
簽發單位聲明:
若因與伊朗外匯清算政策改變,或其他不可控制的外力因素,造成承辦清算銀行無法辦理外匯清算時,本證明書 不保證能透過臺伊外匯清算機制取得貨款。
Approving Agency declares :
Issuance of this confirmation form does not guarantee the completion of financial transactions when the Iran policy of a foreign exchange bank involved or other uncontrollable outside factors would not allow the applicant's bank to process the transactions.
簽發單位簽章 Approving Agency Signature
應檢附文件:
1.海關關章之出口報單證明聯。
2.交易文件、產品型錄、產品規格、成分/用途說明書。
Required Documents:
1.Submit the export declaration.
2.File related transaction documents and other documents indicating the functions, usage and descriptions of the requested items such as manuals, catalogues, or specifications.
輸出伊朗貨品證明書
Certificate of Exporting Goods to Iran
證號 Issue No.
核發日期 Issue Date 有效期限 Expiry Date
出口報單號碼:
Export declaration No.
.
* 申請人 (出口人) Applicant(
Exporter) 名稱
Name of Exporter
聯絡人
Name of Applicant 地址
Address
負責人
Name of Representative 電話 Telephone
統一編號 Business Registration No.
傳真 Fax 電子郵件 e-mail address
* 進口人 Importer
名稱
Name of Importer 電話 Telephone
地址 Address
* 買方 Buyer
名稱
Name of Buyer 電話 Telephone
地址 Address
運送人 Forwarder
名稱
Name of Forwarder
船名 vessel name
地址 Address 電話 Telephone
* 項 次 Item
*
貨品分類號列 CCC Code
*貨品明細 Specifications of Goods
*數量/單位 Quantity
*單價 Unit Price (USD)
*總價 Total Value (USD)
交易文件號碼/日期 Contract No./ Date of Contract
(yyyy/mm/dd) 貨品名稱及貨品型號
Model Number & Name
貨品規格、成分/貨品 用途
Specifications/Usage
第3 聯:申請人留存聯(For Applicant’s files) 收件編號:
出口人聲明輸出貨品是否屬戰略性高科技貨品種類
*
確認貨品是否屬戰 略性高科技貨品輸 出管制清單
(請連結
Classification Search Tool#篩選)
Item Classification
□ 歐盟軍商兩用貨品及技術
出口管制清單(Community Regime for the Control of Exports of Dual Use Items and Technology)
□ 歐盟一般軍用貨品清單
(Common Military List of the European Union)
□ 輸往北韓及伊朗之敏感貨
品清單(Sensitive Commodities List ,SCL)
□ 非屬前述清單貨品
None of the above list of goods
*
確認交易對象是 否屬國際出口管
制實體名單(請連
結Restricted Parties Screening Tool篩選) Entity Classificaion
進口商 Importer
買方 Buyer
運送人 Forwarder
*
確認本項交易有無異 常情況(請連結紅色 警戒篩選
http://ekm92.trade.gov.
tw/BOFT/OpenFileSer vice?
file_id=870633410387 ee22efc2370d8a2aae1f
&context=83ee4cf785a d25a257533d1ac7c3b8 2f)
Red Flag Classification
□ 有 Yes
□ 無 NO
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
□ 是 Yes
□ 否 No
申請人(出口人)聲明:
上述內容均已據實填報,並已閱讀瞭解『經濟部國際貿易局核發輸出伊朗貨品證明書作業要點』內容及遵守『貿易 法』、『戰略性高科技貨品輸出入管理辦法』之規定,如有不實或有違法情事,願依貿易法第二十七條及第二十七
條之一規定接受刑罰及行政處罰
。
Applicant(Exporter) undertakes:
It is hereby certified that I have filled out this document in good faith and understand the “Operational Guidelines for Certificate of Exporting Goods to Iran issued by BOFT” and comply with the rules of the “Foreign Trade Act” and
“Regulations Governing Export and Import of Strategic High-Tech Commodities”. Any false statement willfully made in this document or occurrence of any violation is subject to criminal punishment and/or administrative sanction in accordance with the Article 27, 27-1 of the “Foreign Trade Act”
申請人 Name of Applicant 簽名 Signature
簽發單位聲明:
若因與伊朗外匯清算政策改變,或其他不可控制的外力因素,造成承辦清算銀行無法辦理外匯清算時,本證明書 不保證能透過臺伊外匯清算機制取得貨款。
Approving Agency declares :
Issuance of this confirmation form does not guarantee the completion of financial transactions when the Iran policy of a foreign exchange bank involved or other uncontrollable outside factors would not allow the applicant's bank to process the transactions.
簽發單位簽章 Approving Agency Signature
應檢附文件:
1.海關關章之出口報單證明聯。
2.交易文件、產品型錄、產品規格、成分/用途說明書。
Required Documents:
1.Submit the export declaration.
2.File related transaction documents and other documents indicating the functions, usage and descriptions of the requested items such as manuals, catalogues, or specifications.