ORIGINAL
1. Goods Consigned from (Exporter’s name, address and Referance No.: VN-KR 23/01/02827
country)
GOLDEN TOP CO., LTD
VIET NAM-KOREA FREE TRADE AGREEMENT
1166 NGUYEN BINH KHIEM STREET, DONG HAI 2 WARD,
PREFERENTIAL TARIFF
HAI AN DISTRICT, HAI PHONG CITY, VIETNAM
CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)
2. Goods Consigned to (Importer’s/Consignee’s name, FORM VK
address, country)
Issued in: VIETNAM
ABC MART KOREA CO. LTD
(Country)
21ST FLOOR, BUILDING B, EULJIRO 100, JUNG-GU,
SEOUL (EULJIRO 2-GA, PINE AVENUE), KOREA See Notes Overleaf
3. Means of transport and route (as far as known) 4. For Official Use
BY SEA FROM HAI PHONG PORT – VIET NAM
Preferential Treatment Given Under Viet Nam-Korea
Departure date: 29.MAY.2023 Free Trade Agreement
Vessel’s name/Aircarft etc.: YM CERTAINTY 039N
Preferential Tariff Treatment Not Given (Please state
reason/s)
Port of Discharge: INCHEON, KOREA
Signature of Authorised Signatory of the Importing Country
5. Item 6. Marks and 7. Number and type of packages, 8. Origin 9. Gross weight or other 10. Number
number numbers on description of goods (including criterion (see quantity and value (FOB and date of
packages quantity where appropriate and Overleaf only when RVC criterion is invoices
HS code of good in the importing Notes) used)
country)
SOCCER SHOES 400 PAIRS
BADMINTON SHOES 400 PAIRS 2103/HD 2023
RUNNING SHOES 600 PAIRS “WO” 1,500.000 kgs
10-MAY-2023
HS code 640411
11. Declaration by the exporter 12. Certification
The undersigned hereby declares that the above details and It is hereby cetified, on the basis of control carried out, that the
statements are correct; that all the goods were produced in declaration by the exporter is correct
VIET NAM
(country)
and that day comly with the rules of origin, as provided in
Chapter 3 of the Agreement Establishing the Viet Nam-
Korea Free Trade Agreement for the goods exported to
KOREA
(importing country)
HAI PHONG – VIET NAM.11.MAY.2023
HAI PHONG,VIET 11 MAY 2023
Place and date, name, signature of authorized
signatory NAM
Place and date, signature and stamp of certifying authority
13. Remarks