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KOREA-CHILE FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN Issuing Number: RKC18-0024 1: Exporter (Name and Address) Rinnai Korea Corporation 826-4, Gajwa3-dong, Seo-gu, Incheon, Korea “Tax ID No: 137-81-00581 2: Producer (Name and Adaress) Rinnai Korea Corporation 525-4, Gajwa3-dong, Seo-gu, Incheon, Korea Tax 10 No: 137-81-00581 porter (Name and Address) Impacon Spa RUT. 76.479.542-3 EI Rosal 5168 , 8590594 Huechuraba Santiago de Chile “4 Description of Good(s) 5 HSNO, Preference 7 Regional Valus | &. Country of Criterion Content Origin = BOILERS SPARE PARTS 8403.90 7 NO KR ‘AF002-1132 FAN MOTOR A’LY-24 WIND PRESSURE BAO49-1433 WATER FILTER ASSY BAO49-1433-2 WATER FILTER ASSY BA049-1474 WATER SUPPLY VALVE(NEW) BA049-1613 HEATING FILTER BAO49-4084 QUICK FASTNER-14,20.4 BA053-2702 FLOW SERVO ASSY BA154-1202-3 SUB HEX ASSY -25 BA154-1202-5 SUB HEX ASSY-38 8A154-2302-2 AIR WATER DISPENSER ASSY A154-3002 FAN MOTOR ASSY BA154-3123 OVER PRESSURE ESCAPE ALY BA154-8502 SWAY VALVE ALY BA154-9014 THERMAL FUSE WIRE BA154-9144 WATER SUPPLY SW. BA158-4302-3 PRESSURE GAUGE. BB864-4302-5 PUMP ALY 7M BB947-5502-3 BODY CONRROLLER ASSY 8D127-1202-44 SUB HEX ASSY -36 BD127-1202-33 SUB HEX ASSY -25 [8D132.2302-1 AIR DISPENSOR AIR VENT ALY 18D192.6202 MAIN UNIT ASSY -RMF \VO34E.001 GAS CONTROL A'LY \VWO1S-001 WATER GOV . VALVE \wwB009-9023 THERMISTOR Ws0U¥-4048 [HERMAL FUSE 9. Remarks: All the goods wil be invoiced by Rinnai Corporation, address 2-26 Fukuzumi-Cho, Nakagawa, Nagoya, Japan ar Carification of Origin | oerty that: ‘9 The information on this document is true and accurate and | assume the responsiblity for providing such representations | understand that | am liable for any fase statements or material omissions made on ‘orn connecton with this document ‘© agree to maintain and present upon request, cocumentation necessary to suppor ths cetfcate, andto Inform, In wing, all persons to whom {he certificate was given of any changes that could affect the accuracy or validty ofthis cortcate '© The goods originated inthe tertory ofthe Parties, and comply wih the origi requirements specie for those goods in KOREA.CHILE FREE ‘TRADE AGREEMENT, and there has been no futher production or any other operation outside the tettores ofthe Parties in accordance wih Aci 412 of the Agreement “Authorized Signature ‘Company Name INNA! KOREA CORPORATION Name(Print OF Typ=) Title Kang Young Chul President Date(MMIDEY) ‘Telephone / Fax (E-mail. ‘0103/2020 (02:98.570.0008/02.92.970.0010/andy@rinnel.co.kr KOREA-CHILE FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN INSTRUCTIONS For purposes of obtaining preferential tar treatment, his document must be completed legibly and in ful by the exporter and be in the possession of the importer atthe time te declaration 's made. Please part or type: Issuing Number: Flin the serial number of he certicateof origin. Field 1: State the ful egal nam, address (including country and legal tax identification number ofthe exporter. Legal tax dentication number is: in Korea, Taxpayer identification Number; in Cio, the Uaue Tax Number (al linen Tatar?) Field 2: If one producer, siate the ful legal name, address (inclucing county, telephone number, fex number and email address) and egal tax ‘dentifcaion number, as defined in Field 1, of said producer. more than one producer i inuded onthe Certincae, state "Various" and stants Int of al producers, including their lgel name, address (incuding county. telephone number, ax number and email address) and legal tax iSenticatian ‘umber, ezos referenced fo the good or goods desende in Field 4. Ifyou wish this information tobe concent, itis acseplable to state Avalabis to Customs upon request’. If he producer and the exporter are the same, complete field with “SAME. I the producar i unknown, ls acceptable to state "UNKNOWN" Field 3. State te ful egal name, address (including country) as defined in Fel 1, ofthe importer ifthe Importer isnot known, state ‘UNKNOWN: if ‘mulpe importers, state "VARIOUSY Field | Prove afl description ofeach good. The dessrition shouldbe sufcen to rele it othe invoice desertion and othe Harmonized System (HS)

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