原產地證明書 (中譯)
1: Exporter (Name and Address) 出口商（名稱與地址)
2: Producer, if known (Name and Address)
（已知之）生產者（名稱與地址）
3: Importer, if known (Name and Address)
（已知之）進口商（名稱與地址）
4. Description of Good(s) 貨名
5. HS Code (six-digits) 國際商品統一分 類號列（六位碼）
6. Preference Criterion 適用優惠標準
7. Producer 生產者
8. Regional Value Content, if required
（必要時） 區域產值 含量
9. Party of Origin 原產之締約方
10: Certification of Origin I certify that:
The information on this document is true and accurate and I assume the responsibility for providing such representations. I understand that I am liable for any false statements or material omissions made on or in connection with this document.
I agree to maintain and present upon request, documentation necessary to support this certificate, and to inform, in writing, all persons to whom the certificate was given of any changes that could affect the accuracy or validity of this certificate.
The goods originated in the Parties, and comply with the origin requirements specified for those goods in the Agreement between the Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu and New Zealand on Economic Cooperation.
10. 原產地證明 本人聲明：
本文件所載資訊係正確詳實並由本人承擔提出此證明之責任，本人瞭解應為不實之聲明或本文件之資料缺漏負責。
本人同意保存本文件之證明資料，於經要求時出示該等證明資料，亦同意於資料更動而影響本文件之正確或合法性時，以
書面通知本原產地證明書之所有收受人。
本文件所列產品係原產於締約之一方，並符合臺灣、澎湖、金門、馬祖個別關稅領域與紐西蘭經濟合作協定規定之原產地
規則。
Authorised Signature 授權簽名 Company Name 公司名稱
Name (Print or Type) 姓名（印刷或打字） Title 職稱
Date (DD/MM/YY) 日期（日/月/年） Contact details – Telephone, Fax and/or E-mail 聯絡資訊 – 電話、傳真及/或電子郵件信箱
原產地證明書填寫說明
依據協定第 3 章第 16 條(貨品申請適用優惠關稅待遇)規定，為獲得優惠關稅待遇，本文件應由出口商、
生產者、供應商、進口商或其他符合資格者，以英語清晰並完整地填寫：
第 1 欄：填寫出口商依法登記的完整名稱與地址。
第 2 欄：如僅涉及一生產者，則填寫該生產者依法登記的完整名稱與地址(包括連絡電話號碼、傳真號碼 及電子郵件)，如證明書載有一家以上之生產者，則於本欄填上「多家廠商」後並對照第 4 欄商 品項目附上所有生產者的清單，包括個別生產者的合法名稱與完整地址(包括連絡電話號碼、傳 真號碼及電子郵件)。如台端希望本資料保密，可在本欄填寫「應要求提供予海關」 。倘生產者即 為出口商，於本欄填寫「同出口商」 。倘無法得知生產者，可在本欄填上「未知」。
第 3 欄：依第 1 欄格式填寫進口商的合法名稱、完整地址。如無法得知進口商，則在本欄填上「未知」；
如有多家進口商，則於本欄填寫「多家廠商」 。
第 4 欄：提供各項貨品之完整貨名，該貨名應足以連結發票上的商品名稱以及該貨品的國際商品統一分 類制度貨名。
第 5 欄：提出第 4 欄所列各項貨品之國際商品統一分類制度之六位碼。
第 6 欄：針對第 4 欄所列各項貨品，出口商、供應商、生產者、進口商或其他符合資格者，應於本欄內 依下表所列代碼填寫該貨品適用優惠關稅待遇之原產地標準：
貨品適用之原產地規則 代碼
符合本協定第 3 章(原產地規則)第 2(a)條規定，於締約一方領域內完
全取得或完全生產 WO
符合本協定第 3 章(原產地規則)第 2(b)條規定，僅使用締約一方或雙 方之原產材料，且完全在締約一方或雙方領域內生產 PE 符合本協定第 3 章(原產地規則)第 2(c)條規定，於締約一方或雙方領 域內以非原產材料所生產，而符合：
- 第 4 條稅則分類變更規定；
- 第 5 條區域產值含量規定；或
- 附件 2(產品特定原產地規則表，以下簡稱「PSR 表」)所列之其 他規定
PSR (CTC) PSR (RVC) PSR (Other)
第 7 欄：倘填寫此表者為第 4 欄所述貨品之生產者，則在本欄填寫「是」 ；倘填寫此表者非貨品之生產者，
則在本欄填寫「否」，並依本證明書之依據於其後添註(1)或(2)：
(1) 依據台端之認知該貨品為原產貨品；及
(2) 依生產者所填寫並簽名且主動提供予出口商之原產地聲明。
第 8 欄：倘第 4 欄所列貨品適用本協定之區域產值含量規定，於本欄填列每項最終貨品之產值百分比。
第 9 欄：說明原產地(如貨品係原產於臺灣、澎湖、金門、馬祖個別關稅領域，則填寫「TW」；如貨品係 原產於紐西蘭，則填寫「NZ」)。
第 10 欄：本欄應由出口商、生產者、供應商、進口商或其他符合資格者填寫、簽名並註明日期，日期應 為本證明書完成並簽署日期。
本說明僅係填寫原產地證明書之參考，出示原產地證明書時無須檢附。
Certificate of Origin
Agreement between the Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu and New Zealand on Economic Cooperation
CERTIFICATE OF ORIGIN
1: Exporter (Name and Address)
2: Producer, if known (Name and Address) 3: Importer, if known (Name and Address)
4. Description of Good(s)
5. HS Code (six-digits)
6. Preference Criterion
7. Producer 8. Regional Value Content, if required
9. Party of Origin
10: Certification of Origin I certify that:
The information on this document is true and accurate and I assume the responsibility for providing such
representations. I understand that I am liable for any false statements or material omissions made on or in connection with this document.
I agree to maintain and present upon request, documentation necessary to support this certificate, and to inform, in writing, all persons to whom the certificate was given of any changes that could affect the accuracy or validity of this certificate.
The goods originated in the Parties, and comply with the origin requirements specified for those goods in the Agreement between the Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu and New Zealand on Economic Cooperation.
Authorised Signature Company Name
Name (Print or Type) Title
Date (DD/MM/YY) Contact details – Telephone, Fax and/or E-mail
Agreement between the Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu and New Zealand on Economic Cooperation
CERTIFICATE OF ORIGIN INSTRUCTIONS
Pursuant to Article 16 (Treatment of Goods for which Preference is Claimed) of Chapter 3 of the Agreement, for the purposes of obtaining preferential tariff treatment this document must be completed legibly, in English and in full by the exporter, producer, supplier, importer or other competent person:
Field 1: State the full legal name and address of the exporter.
Field 2: If one producer is involved, state the full legal name, full address (including, telephone number, fax number and email address), of that producer. If more than one producer is included on the Certificate, state ‘Various’ and attach a list of all producers, including their legal names, full addresses (including, telephone numbers, fax numbers and email addresses),cross referenced to the good or goods described in Field 4. If you wish this information to be confidential, it is acceptable to state ‘Available to Customs upon request’. If the producer and the exporter are the same, complete Field 2 with ‘SAME’. If the producer is unknown, it is acceptable to state ‘UNKNOWN’.
Field 3: State the full legal name, full address as defined in Field 1, of the importer; if the importer is not known, state ‘UNKNOWN’; if multiple importers, state ‘VARIOUS’.
Field 4: Provide a full description of each good. The description should be sufficient to relate it to the invoice description and to the Harmonized System (HS) description of the good.
Field 5: For each good described in Field 4, identify the HS tariff classification to six digits.
Field 6: For each good described in Field 4, the exporter, supplier, producer, importer or other competent person must indicate in Field 6 of this form the origin criteria by which it is claimed the good qualifies for preferential tariff treatment, in the manner shown in the following table:
Goods wholly obtained or produced in a Party, satisfying Article 2(a) of Chapter 3 (Rules of Origin) of the Agreement
WO
Goods produced entirely in one or both Parties exclusively from originating materials from one or both of the Parties, satisfying Article 2(b) of the Chapter 3 (Rules of Origin) of Agreement
PE
Goods produced in one or both Parties using non-originating materials, provided that the goods satisfy Article 2(c) of Chapter 3 (Rules of Origin) through a:
- Change in Tariff Classification requirement (as provided for in Article 4);
- a Regional Value Content requirement (as provided for in Article 5); or
- other requirements as specified in Annex 2 (Product Specific Rules Schedule, hereinafter referred to as PSR Schedule).
PSR (CTC)
PSR (RVC)
PSR (Other)
Field 7: For each good described in Field 4, state ‘YES’ if you are the producer of the good. If you are not the producer of the good, state ‘NO’ followed by (1) or (2), depending on whether this certificate was based upon:
(1) your knowledge of whether the good qualifies as an originating good; or (2) the producer's written Declaration of Origin, which is completed and signed by
the producer and voluntarily provided to the exporter by the producer.
Field 8: For each good described in Field 4, where the good is subject to a regional value content (RVC) requirement stipulated in the Agreement, indicate the actual percentage content in each final good.
Field 9: Identify the origin (‘TW’ for all goods originating from the Separate Customs Territory of Taiwan, Penghu, Kinmen, and Matsu or ‘NZ' for all goods originating from New Zealand).
Field 10: This field must be completed, signed and dated by the exporter, producer, supplier, importer or other competent person. The date must be the date the certificate was completed and signed.
These instructions are a guide for completing the certificate of origin; the instructions do not have to appear on the completed certificate of origin.
