證號Certificate No.
中 華 民 國
戰略性高科技貨品抵達證明書 申請書
APPLICATION FOR
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期Issue Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
輸入口岸Port of Entry 到岸日期Arrival Date 進口報單號碼Customs Import Declaration No.
運輸工具名稱／海空運提單號碼 Name of Carrier/Airway Bill or B/L No.
國際進口證明書或保證文件號碼
Corresponding IC or Written Assurance No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
本證明書進口人如有申報不實或有違法情事願依貿易法第二十七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
Any false statement willfully made by importer in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
茲證明進口人已獲准將上述貨品輸入中華民國國境，並經我國政府認可及納入“性高科技貨品輸出入管理辦法”之管理。
It is certified that the importer has produced evidence that the goods specified above have been delivered and brought under
“Regulations Governing Export and Import of Strategic Hi-Tech Commodities” of the Republic of China.
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第一聯 國際貿易局留存(For BOFT’s files) (Total Page(s), of )
收件日期及編號Rept Date & No.
中 華 民 國
戰略性高科技貨品抵達證明書申請書
（貨品明細加貼聯）
APPLICATION FOR
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
（COMMODITY DESCRIPTION SUPPLEMENT）
證號Certificate No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第一聯 國際貿易局留存(For BOFT’s files) (Total Page(s), of )
收件日期及編號Rept Date & No.
證號Certificate No.
中 華 民 國
戰略性高科技貨品抵達證明書
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期Issue Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
輸入口岸Port of Entry 到岸日期Arrival Date 進口報單號碼Customs Import Declaration No.
運輸工具名稱／海空運提單號碼 Name of Carrier/Airway Bill or B/L No.
國際進口證明書或保證文件號碼
Corresponding IC or Written Assurance No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
本證明書進口人如有申報不實或有違法情事願依貿易法第二十七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
Any false statement willfully made by importer in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
茲證明進口人已獲准將上述貨品輸入中華民國國境，並經我國政府認可及納入“性高科技貨品輸出入管理辦法”之管理。
It is certified that the importer has produced evidence that the goods specified above have been delivered and brought under
“Regulations Governing Export and Import of Strategic Hi-Tech Commodities” of the Republic of China.
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第二聯 由進口人寄送出口人 (For importer to send to exporter) (Total Page(s), of )
收件日期及編號Rept Date & No.
中 華 民 國
戰略性高科技貨品抵達證明書
（貨品明細加貼聯）
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
（COMMODITY DESCRIPTION SUPPLEMENT）
證號Certificate No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第二聯 由進口人寄送出口人 (For importer to send to exporter) (Total Page(s), of )
收件日期及編號Rept Date & No.
證號Certificate No.
中 華 民 國
戰略性高科技貨品抵達證明書
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期Issue Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
輸入口岸Port of Entry 到岸日期Arrival Date 進口報單號碼Customs Import Declaration No.
運輸工具名稱／海空運提單號碼 Name of Carrier/Airway Bill or B/L No.
國際進口證明書或保證文件號碼
Corresponding IC or Written Assurance No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
本證明書進口人如有申報不實或有違法情事願依貿易法第二十七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
Any false statement willfully made by importer in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
茲證明進口人已獲准將上述貨品輸入中華民國國境，並經我國政府認可及納入“性高科技貨品輸出入管理辦法”之管理。
It is certified that the importer has produced evidence that the goods specified above have been delivered and brought under
“Regulations Governing Export and Import of Strategic Hi-Tech Commodities” of the Republic of China.
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第三聯 進口人留存 (For importer’s files) (Total Page(s), of )
收件日期及編號Rept Date & No.
中 華 民 國
戰略性高科技貨品抵達證明書
（貨品明細加貼聯）
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
（COMMODITY DESCRIPTION SUPPLEMENT）
證號Certificate No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第三聯 進口人留存 (For importer’s files) (Total Page(s), of )
收件日期及編號Rept Date & No.
證號Certificate No.
中 華 民 國
戰略性高科技貨品抵達證明書
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期Issue Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
輸入口岸Port of Entry 到岸日期Arrival Date 進口報單號碼Customs Import Declaration No.
運輸工具名稱／海空運提單號碼 Name of Carrier/Airway Bill or B/L No.
國際進口證明書或保證文件號碼
Corresponding IC or Written Assurance No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
本證明書進口人如有申報不實或有違法情事願依貿易法第二十七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
Any false statement willfully made by importer in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
茲證明進口人已獲准將上述貨品輸入中華民國國境，並經我國政府認可及納入“性高科技貨品輸出入管理辦法”之管理。
It is certified that the importer has produced evidence that the goods specified above have been delivered and brought under
“Regulations Governing Export and Import of Strategic Hi-Tech Commodities” of the Republic of China.
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第四聯 由國際貿易局寄送出口國發證機關
(For BOFT to send to the authority of exporting country) (Total Page(s), of )
收件日期及編號Rept Date & No.
中 華 民 國
戰略性高科技貨品抵達證明書
（貨品明細加貼聯）
DELIVERY VERIFICATION CERTIFICATE OF THE REPUBLIC OF CHINA
（COMMODITY DESCRIPTION SUPPLEMENT）
證號Certificate No.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS 進口人印鑑
Stamp of Importer
主管職銜及簽名 Title & Signature of Official
發證機構印信 Official Stamp
海關確認進口核章及日期 Stamp of Customs Office and Date
第四聯 由國際貿易局寄送出口國發證機關
(For BOFT to send to the authority of exporting country) (Total Page(s), of )
收件日期及編號Rept Date & No.
