Ⅰ 申请单位信息

  Institution of Application

1. 申请单位名称Name of Application Institution

ABC CHEMICALS COMPANY

(Company Introducing Chemical to China)

2. 申请单位地址Address of Application Institution

Oxford Street 007, London, XXX

(Address of Applicant Company)

3. 申请登记代表姓名及职务Name and Title of Applicant

Tom Cruise   Executive Director

(The Title/Duty of reprehensive must be indicated)

4. 申请登记代表签名Signature of Applicant

“Tom Cruise”

(The only item filled by handwriting)

5. 联系人Person to Contact With

(1) 姓名Name

Liu Hua

(2) 电话Telephone

010-87654321

(3) 传真Fax

010-12345678

(4) 电子邮件E-Mail

???@???.com

(5) 通信地址及邮政编码Mail Address & Zip Code

Please leave address in Chinese, if it is located in Mainland China;
DO NOT OMIT ZIP CODE.

6. 申请日期Application Date

2008-9-1

7. 备注Remarks

If company or applicant will arrange the collection themselves, please indicate so. Otherwise, CRC will post the Certificate document by EMS to above “Mail Address”.

Ⅱ 进口信息

   Import Specifications

1. 化学名称IUPAC Name（国际纯化学及应用化学联合会化学品名）

   中文化学名Chinese

   英文化学名English

2. 商品名称（□ 纯物质  □ 制剂）Trade Name（□ Pure  □ Preparation）

   中文商品名Chinese

   英文商品名English

3. 其他名称 Other Name

   中文其他名Chinese

   英文其他名English

4. 美国化学文摘社(CAS)登记号US CAS Number

5. 纯度%  Purity %

6. 商品编码H.S. Code

7. 进口数量（千克）Quantity for Import (kg)

8. 进口用途Usage of Import Chemicals

9. 原产地国（地区）Country/Region of Origin

10. 贸易方式Terms of trade

11. 合同对方Contract Partner

12. 合同号Contract Number