第1聯 國際貿易局留存 (For BOFT’s files) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書申請書
APPLICATION FOR
INTERNATIONAL IMPORT CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期 Issue Date 有效日期 Expiry Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS
發證機構印信 Official Stamp
主管職銜及簽名
Title & Signature of Official
茲證明進口人已向本發證機構具結以下內容，本證明書副本並以存檔列管。
It is hereby certified that the following declaration was made to this certifying authority and a copy of this Certification is placed in the official files.
進口人切結：
(一) 貨品將依申辦內容輸入中華民國境內，未經原發證機構核准絕不變更進口人或轉運至第三國家或地區。
(二) 本證明書所載內容如需變更，應向原發證機構重新申請。
(三) 有需要檢具抵達證明書時， 應依規定申請核發並寄送出口人。
(四) 申辦內容均已據實填報並願遵守“戰略性高科技貨品輸出入管理辦法”之規定，如有不實或有違法情事願依貿易法第二十 七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
The importer undertakes：
1. to import into the Republic of China the goods described and will not change the importer, divert, transship, or reexport the goods to another destination except with the approval of the certifying authority.
2. to reapply for a new certificate if any changes of fact or intention set forth herein.
3. to obtain a Delivery Verification Certificate and furnish it to the exporter, if such certificate is required.
4. to fill out this document in good faith and to comply with the “Regulations Governing Export and Import of Strategic Hi-Tech Commodities”. Any false statement willfully made in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) 數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc) Description of Goods
第1聯 國際貿易局留存 (For BOFT’s files) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書申請書續頁
CONTINUED PAGES OF
發證日期Issue Date 有效日期
APPLICATION FOR
INTERNATIONAL IMPORT CERTIFICATE
OF THE REPUBLIC OF CHINA
Expiry Date 貨品分類號列C.C.C. Code (ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
第2聯 由進口人寄送出口人 (For importer to send to exporter) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書
INTERNATIONAL IMPORT CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期 Issue Date 有效日期 Expiry Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS
發證機構印信 Official Stamp
主管職銜及簽名
Title & Signature of Official
茲證明進口人已向本發證機構具結以下內容，本證明書副本並以存檔列管
It is hereby certified that the following declaration was made to this certifying authority and a copy of this Certification is placed in the official files.
進口人切結：
(一) 貨品將依申辦內容輸入中華民國境內，未經原發證機構核准絕不變更進口人或轉運至第三國家或地區。
(二) 本證明書所載內容如需變更，應向原發證機構重新申請。
(三) 有需要檢具抵達證明書時， 應依規定申請核發並寄送出口人。
(四) 申辦內容均已據實填報並願遵守“戰略性高科技貨品輸出入管理辦法”之規定，如有不實或有違法情事願依貿易法第二十 七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
The importer undertakes：
1. to import into the Republic of China the goods described and will not change the importer, divert, transship, or reexport the goods to another destination except with the approval of the certifying authority.
2. to reapply for a new certificate if any changes of fact or intention set forth herein.
3. to obtain a Delivery Verification Certificate and furnish it to the exporter, if such certificate is required.
4. to fill out this document in good faith and to comply with the “Regulations Governing Export and Import of Strategic Hi-Tech Commodities”. Any false statement willfully made in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
第2聯 由進口人寄送出口人 (For importer to send to exporter) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書續頁
CONTINUED PAGES OF
INTERNATIONAL IMPORT CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期 Issue Date 有效日期 Expiry Date 貨品分類號列
C.C.C. Code (ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
第3聯 進口人留存 (For importer’s files) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書 INTERNATIONAL IMPORT CERTIFICATE
發證日期 Issue Date
OF THE REPUBLIC OF CHINA
有效日期Expiry Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS
發證機構印信
主管職銜及簽名
Title & Signature of Official
Official Stamp
茲證明進口人已向本發證機構具結以下內容，本證明書副本並以存檔列管
It is hereby certified that the following declaration was made to this certifying authority and a copy of this Certification is placed in the official files.
進口人切結：
(一) 貨品將依申辦內容輸入中華民國境內，未經原發證機構核准絕不變更進口人或轉運至第三國家或地區。
(二) 本證明書所載內容如需變更，應向原發證機構重新申請。
(三) 有需要檢具抵達證明書時， 應依規定申請核發並寄送出口人。
(四) 申辦內容均已據實填報並願遵守“戰略性高科技貨品輸出入管理辦法”之規定，如有不實或有違法情事願依貿易法第二十 七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
The importer undertakes：
1. to import into the Republic of China the goods described and will not change the importer, divert, transship, or reexport the goods to another destination except with the approval of the certifying authority.
2. to reapply for a new certificate if any changes of fact or intention set forth herein.
3. to obtain a Delivery Verification Certificate and furnish it to the exporter, if such certificate is required.
4. to fill out this document in good faith and to comply with the “Regulations Governing Export and Import of Strategic Hi-Tech Commodities”. Any false statement willfully made in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
貨品分類號列 貨品明細(名稱、型號、規格) 數量/單位 金額(貨價條件) C.C.C. Code
Description of Goods Quantity Value(FOB,CIF,etc)
(ECCN)
第3聯 進口人留存 (For importer’s files) (Total Page(s), of )
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書續頁
發證日期 Issue Date
CONTINUED PAGES OF
INTERNATIONAL IMPORT CERTIFICATE
有效日期OF THE REPUBLIC OF CHINA
Expiry Date 貨品分類號列貨品明細(名稱、型號、規格) 數量/單位 金額(貨價條件) C.C.C. Code
Description of Goods Quantity Value(FOB,CIF,etc)
(ECCN)
第4聯 由國際貿易局寄送出口國發證機關 (Total Page(s), of ) (For BOFT to send to the authority of exporting country)
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書
INTERNATIONAL IMPORT CERTIFICATE OF THE REPUBLIC OF CHINA
發證日期 Issue Date 有效日期 Expiry Date
進口人(名稱及地址) Importer(Name and Address) 出口人(名稱及地址) Exporter(Name and Address)
發證機構：經濟部國際貿易局 Certifying Authority:
BUREAU OF FOREIGN TRADE MINISTRY OF ECONOMIC AFFAIRS
主管職銜及簽名
Title & Signature of Official
發證機構印信 Official Stamp
茲證明進口人已向本發證機構具結以下內容，本證明書副本並以存檔列管
It is hereby certified that the following declaration was made to this certifying authority and a copy of this Certification is placed in the official files.
進口人切結：
(一) 貨品將依申辦內容輸入中華民國境內，未經原發證機構核准絕不變更進口人或轉運至第三國家或地區。
(二) 本證明書所載內容如需變更，應向原發證機構重新申請。
(三) 有需要檢具抵達證明書時， 應依規定申請核發並寄送出口人。
(四) 申辦內容均已據實填報並願遵守“戰略性高科技貨品輸出入管理辦法”之規定，如有不實或有違法情事願依貿易法第二十 七條、二十七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。
The importer undertakes：
1. to import into the Republic of China the goods described and will not change the importer, divert, transship, or reexport the goods to another destination except with the approval of the certifying authority.
2. to reapply for a new certificate if any changes of fact or intention set forth herein.
3. to obtain a Delivery Verification Certificate and furnish it to the exporter, if such certificate is required.
4. to fill out this document in good faith and to comply with the “Regulations Governing Export and Import of Strategic Hi-Tech Commodities”. Any false statement willfully made in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”.
貨品分類號列 C.C.C. Code
(ECCN)
貨品明細(名稱、型號、規格) Description of Goods
數量/單位 Quantity
金額(貨價條件) Value(FOB,CIF,etc)
第4聯 由國際貿易局寄送出口國發證機關 (Total Page(s), of ) (For BOFT to send to the authority of exporting country)
證號Certificate No.
中 華 民 國
戰略性高科技貨品國際進口證明書續頁
發證日期 Issue Date
CONTINUED PAGES OF
INTERNATIONAL IMPORT CERTIFICATE
有效日期OF THE REPUBLIC OF CHINA
Expiry Date 貨品分類號列貨品明細(名稱、型號、規格) 數量/單位 金額(貨價條件) C.C.C. Code
Description of Goods Quantity Value(FOB,CIF,etc)
(ECCN)
