■ 자유무역협정의 이행을 위한 관세법의 특례에 관한 법률 시행규칙 [별지 제19호서식] 호주와의 협정에 따른 원산지증명서의 서식 (앞쪽) korea-australia free trade agreement certificate of origin 1.issuing number: 2.exporter-name and contact details: 3.blanket period for multiple shipments: from: (dd/mm/yyyy) to: (dd/mm/yyyy) 4.producer-name and contact details (optional field): 5.importer-name and contact details (optional field): 6.description of good(s) (including quantity, invoice number or other unique reference number where appropriate): 7.harmonized system code(six digits): 8.preference criterion: 9.observations (optional field): 10.declaration: i certify that: -the information in this document is true and accurate and i assume the responsibility for proving 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 would affect the accuracy or validity of this certificate. -the goods originate in the territory of one or both parties and comply with the origin requirements specified for those goods in the korea-australia free trade agreement. this certificate consist of pages, including all attachments. 11.signature: company or authorised bodname: title: date: contact details: 210mm×297mm[백상지 80g/㎡(재활용품)] (뒤쪽) 작 성 방 법 ※ 이 서식은 수출자, 생산자 또는 원산지증명서발급기관(호주의 발급권한이 있는 기관에 한정한다)이 명료하고 충분하게 작성해야 하며 협정관세의 적용을 신청할 때에 수입자가 갖추고 있어야 합니다.이 서식은 영문으로 작성되어야 하며 타자로 치거나 인쇄체로 기재해야 합니다.작성