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1.Exporter's name and address: (PAGE 1 OF 2)

GUANGXI LIUGONG MACHINERY CO., LTD C Certificate No.: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
NO.1 LIUTAI ROAD,LIUZHOU,GUANGXI ,545007 , P.R er
CHINA
CERTIFICATE OF ORIGIN
2.Producer's name and address, if known: Form for China-Peru FTA
SAME
非有效证书

Issued in the People's Republic of China

(see Overleaf Instruction)
3.Consignee's name and address:
FULLEN INTERNACIONAL PERU SAC
ADD:PERU-OTHER-LURINAUT.
PANAMERICANA SUR KM.29.5
ALMACENES ALBO – LURIN
4.Means of transport and route (as far as known): For Official Use Onley:
Departure Date : APR. 03,2024

Vessel/Flight/Train/Vehicle No. : CMA CGM LYRA/OPPTQE1MA

Port of loading : SHEKOU,CHINA Verification:origin.customs.gov.cn
5.Remarks:
Port of discharge : CALLAO,PERU
N/M

8.HS code (Six digit 9.Origin criterion 10.Gross weight, quantity( 11.Number and 12.Invoiced value
6.Item 7.Number and kind of packages; description
code) Quantity Unit) or other date of invoices
number of goods
(Max 20) measures( liters, m3,etc.)
1 GREASE SEAL;GB/T 9877 8484.90 “WP” 16 UND PPE2114152402002 EXW USD
Mar 21,2024 3139.18

2 VALVE COVER GASKET –

GASKET -ROCKER LEVER 3926.90 “WP” 147 UND 146 VALIDAR
HOUSING GASKET

3 PLUG WELD – BOLT -

BOLT;GB/T 5782- 2000;M27×80 - 7318.15 “WP” 213 UND
BOLT;M20×80- 8.8-Zn.D;STL

NUT;GB/T 6170- 2000;M20-8- 200 UND

4 NUT;GB/T 6170- 2000;M27-10 7318.16 “WP”

5 WORK LIGHT;LED;ASSY -
WORK LIGHT;AGGL - WORK 9405.19 “WP” 40 UND
LIGHT;SWL- 027;ASSY
6 RADIO;AGGL 8527.29 “WP” 2 UNID
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13.Declaration by the exporter: 14.Certification:
The undersigned hereby declares that the above details and On the basis of control carried out, it is hereby certified that the information
statement are correct,that all the goods were produced in herein is correct and that the goods described comply with the origin
requirements specified in the China-Peru FTA.
CHINA
.....................................................................................................................................
(Country)
and that they comply with the origin requirements specified in the FTA for the
goods exported to
PERU
.....................................................................................................................................
(Importing country)

Nanning, China,XXXXXXXXXXX
.................................................................................................................................. ....................................................................................................................................
Place and date,signature of authorized signatory Place and date,signature and stamp of authorized body
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