This sample saleable form is for reference only.   Downloading this form for submission will not be accepted.
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TIC 185B  (Rev.)

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                                          This page to be completed by the Exporter

TIC 185B  (Rev.)
Exporter (Name and Address)



Business
Reg. No.
Tel. No.
Stamps to be affixed here
(Torn or defaced stamps will not be accepted)

THE GOVERNMENT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION
IMPORT AND EXPORT ORDINANCE:
EXPORT (CERTIFICATES OF ORIGIN) REGULATIONS
Application to the Director-General of Trade and Industry by an Exporter for a Certificate of Origin Form A
and declarations by a *Manufacturer/Producer/Subcontractor and Exporter in support thereof

    1.   I ........................................................   *Proprietor               of the above-named exporting firm, the exporter
                     (Insert Name)                               Partner
                                                                        Principal Official

of the merchandise specified in this application, apply for a CERTIFICATE OF ORIGIN FORM A and hereby declare : --
(a)  that I am duly authorized to make and sign this declaration on behalf of the above-named exporting firm;
(b) that the merchandise described below consists exclusively of the goods *manufactured/produced by the *manufacturer/producer/subcontractor described overleaf and will be exported by me in the manner described below;
(c)  that I *have/have not applied to any other Issuing Authority for a Certificate of Origin in respect of the consignment described hereunder;
(d) that all the information I have given in this application is true and correct.

    2.   Should samples of the goods under application be required for scrutiny, these may be obtained by contacting.

Departure Date
Vessel/Flight No. Sea/Airport of Loading Mr./Ms. ...................   Tel. No. .........................
*Delete wherever inapplicable
Port of Discharge Final Destination if on Carriage

If the goods do not carry any
labels or brand names the word `none' should be inserted↓
Marks, Nos. and Container No.; No. and Kind of Packages; Description of Goods No. of Units &
Unit Price		 FOB Value
(HK D)		 Brand names or labels
WARNING: The penalty for making a false declaration in respect of a Certificate of Origin Form A or substitution of goods in respect of a Certificate of Origin Form A is $500,000 and two years' imprisonment. Grand Total
FOB Value		         

Destination Country & Code

Date and Number (For Departmental Use Only)
Note 1 This application and declaration must be made personally by the proprietor or by a partner or principal official authorized by the firm or company exporting the goods.
Note 2  It must be presented to a Certificate of Origin Office of the Trade and Industry Department at least 2 clear working days in advance of the advertised departure date of the vessel concerned.
For Departmental Use Only
Accepted Remarks

Signatory's Name in Block Letters

Date & Signature & Company Chop
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