附件6
出口人名稱及地址
Exporter’s Name and Address證號
Certificate No.輸往越南彩色鋼板配額證明書
SAFEGUARD QUOTA CERTIFICATE OF Pre-painted Galvanized Steel Sheet and Strip
Export to Vietnam
(申請書)
進口人名稱及地址
Importer’s Name and Address卸貨港
Port of Discharge□
海防市
Hai Phong City□
胡志明市 Ho Chi Minh City裝貨港
Port of Loading項次
Item貨品號列(臺灣)*
HS Code (TW)
稅則號別(越南)*
HS Code (VN)
貨品描述含名稱、型號、規格
Description of Goods數量/單位
Quantity/Unit申請人（出口人）切結：The exporter hereby declares that：
1.本證明書內所列之貨品原產地為臺灣。
The goods listed in this certificate originate in Taiwan.
2.本證明書內所列之貨品符合下列原產地認定標準：(①~⑤請勾選1項) □①我國完全取得 The goods are obtained completely in Taiwan.
□②我國完全生產 The goods are produced entirely in Taiwan.
貨品之加工製造涉及我國與其他國家或地區共同參與者，以在我國境內產生最終實質轉型者為限：
The goods that use non-originating materials conform to the following rules:
□③貨品經加工或製造後稅則前6位碼改變 The non-originating materials used in the production of the goods shall undergo a change of Tariff Subheading, CTSH.
□④貨品經加工或製造後未造成稅則前6位碼改變，但附加價值率超過35% The non-originating materials used in production have not undergone a change of Tariff Subheading, but the Value Added Rate exceeds 35%.
□⑤貨品經加工或製造後未造成稅則前6位碼改變，但符合貿易局公告之重要製程者 The non-originating materials used in production have not undergone a change of Tariff Subheading, but the processing operations specified by the BOFT have been conducted in Taiwan.
3.上述內容均已據實填報，如有不實或有違法情事，願依貿易法第28條規定接受行政處罰。
This certificate is truthfully filled out. Any false statement made in this document or violation of the relevant laws is subject to administrative penalty in accordance with Article 28 of the “Foreign Trade Act”.
