CCIC申请表PC证书申请表委托单

CCIC REF.NO.（指令号）（由CCIC1MPORT1NG COUNTRY（进口国别）Date（日期）填写）□KENYA（肯尼亚）口NIGERIA（尼日利亚）□EGYPT（埃及）口IRAN（伊朗）□TANZAN1A（坦桑尼亚）口BOTSWANA（博茨瓦纳）□COTE DLVO1RE（科特迪瓦）口ZANZ1BAR（桑给巴尔）□Others（其他）The Typeof CertificateApp1ied For（所申请证书类型）口ProductCertificate1（Unregistered）PC1（未注册状态产品证书）□Product Certif icate2（Registered）PC2（注册状态产品证书）口ProductCertificate3（Licenced）PC3（许可状态产品证书）□CoC/□SC/□VoC（符合性证书）/□C0I（检验证书）□Regi strat ionCertificate（产品注册证）口License Certificate（产品许可证）Exporter DetaiIs（出口商信息）Name/名称Address/地址Telephone:（联系电Contact Person:（联系人）话）Fax:（联系传真）E-Mail:（联系电邮）Importer DetaiIs（进口商信息）名称Name/地址Address/Telephone:（联系电Contact Person:（联系人）话）Fax:（联系传真）E-Mail:（联系电邮）Book ing Inspect ion（预约检验）Remark:Al IGoods ShouId BeConcentrated OneSame PlaceFor TestInspecti on（备注所有货物必须集中到一个所在地测试和检验）Contact Person:（联系DateTime:（时间）人）Goods ofLocation:（地点）Telephone:（联系电话）Sh ipmentDefa iI s（出运信息）Remark:For Certificateof ConformityRequest（申请CoC/SC/VoC/COI证书，请填写）Country ofOrigin（原产Packages/Qty（包装及数量）国）Port ofLoading（出运港）Port ofDischarge（卸货港）Expected Shi pmentDate□Air（空运）口Sea（海运）□FCL（整柜）（预期出运日期）□Part-口Sup.Of Loadi ngModeof Transport（第几批出运）（监督装柜）（出运方式）Partial ShipmentStatus□x2（r/□TotaI（分批出运状况）x40（整批出运）口LCL（散装）□Final（最终出运）Final Invoi ceNo.Import LicenseNo.Dated（发票号码/日期）（进口许可证号妈）Documents WithThis Request:（所附文件资料）□Valid Test Report/Test Certificate口Supp1i ersDeclaration OfConfi rm（有效测试报告/证书）（供应商声明）□Copy OfISO QMSCertification（ISO9001,••,）口Product SpecificationSheet,MSDS（ISO质量认证等体系复印件）（产品规格表，材质安全数据表）口Factory Inspection/TestReport口Photographs OfProducts（厂检/测试报告）（产品图片）□Invoice（发票）口Packing List（装箱单）□B/L orAWB（提单）口L/C（lf Any,如有）□Others,Please Specify（其他，请说明）（备注）Remarks AndComments:申投诉途径（Comp I a int ChanneI s）:

1、固定电话（Tel.No.）:010-

846031702、电子由1箱（Ema iI）:zhouzheng@cc ic.comNotes Asfollowing:（须知）

1.For eachshipment ofgoods,importer wiI Ineed aCOC or SC toclear thegoods fromcustoms inImport ingCountry（对于每一批出运货物，进口商都必须获得证书才能，□国海关办理清关）；

2.Exporters shouldprovide uswith acopy of the finalinvoice,packing Iist,B/L andAWB forthe certificateprocedure（出证需要出口商提供给我们最终发票、装箱海运提单和航空提单的复印件）；

3.Your shipmentmay beperformed testingat randomintervaIs basedon risk assessment（在风险评估的基础上，您的货物可能会祓随机抽样测试）；

4.If withoutwitnessing containerloading byCCIC,the CoCorSCor VoCcertificate providesconfirmation onlythat thestipulated productsconform to the esserrtrequirementsof sonapproved standards,it doesnot verifythe actualquantity shippedand anyinformation presentedwith respectto quantityand descriptionis drdirectly fromthe exportersfinalinvoice and/or packing Iist.It isthe soleresponsibi Iityof theexporter toensure thatthe productsshipped arein accordawith thei rproduct standardand contractuaIobi igat ionstothebuyer•（不实施集装箱监装的情况下，CoC/SC/VoC证书只证明规定产品符合进口国已批准的标准的基本要求，「验证实际装运数量，关于数量和产品描述的信息都是直接依据出口商的最终发票和/或装箱单保证出运产品符合进口国标准局产品证书和买方的合同要求是出口商必须的责任）.

5.I shaI I takefulI responsibiIityfor anyadditional productswhich havenothing todo withthe inspectionin thisshipment.在本批出运的货物中，如夹带其他额外与本次检验无关的产品，本人将承担全部责任.

6.Al Imaterials providedthis time,such asgoods,HS CODEtest report,system certif icate,packingIi stand invoice,etc.,are true.If theyare forgedand faIwiI Ibear aIIconsequences andliabilities本次提供的所有资料如货物、商品编码、测试报告、体系证书、装箱单和发票等是真实的若系伪造、虚假的，将承担一切后果和责任including theHS code,standard information.IaI soagree toshare anyofthedata,results anddocumentation gatheredand generateddur ing theperformance oft servicewiththe concernedauthor iti es.and toassume correspondinglegal responsibiI ities andobiigat ions.本人同意上述注意事项并承诺此申请表中填写的内容包括货物、海关编码、标准信息等真实、准确、完整本人也愿意与相关授权机构分享在整个服务履行过程中获取的任何数结果及资料等并承担相应的法律责任和义务Signature Date（签名）（日期）委托单（RFC）CCIC-08-QRD

（001）-01-04-2020REQUEST FORMFOR CERTIFICATE续表CONTINUE SHEETItemNo.HS CodeQuantity BrandName ModelNo.（型Product Descri ptionMaterial材质Product StandardRegistration/Manufacturer*Name（序号）（HS编码）（数量）（品牌）号）（产品名称描述）/原料（产品标准）License（if Any）Tel.PCS/SETS（注册/许可号）（如生产商/制造商名称联系电有）话以上资料经CCIC评审Review:

1.产品风险等级Products RisksLeveI:□High-Level口Middle-Level口Low-Level

2.贸易风险（出口商和进口商）等级（Trade Risks（ExporterImporter）LeveI）□High-Level口Middle-Level口Low-Level

3.Result:□接受（Accept）□不接受（Non-accept）原因（Reasons■CCIC评审人（Audi tor）:日期（Date）:CCIC复核人（Reviewer）:日期（Date）:2021年01月01日第页/共页。