Self-Certification of Grape Wine Imported into Taiwan 	

	1. Producer Name and Registered Business Address： 
SARL François PARENT
14 bis rue Pierre Joigneaux
21200 BEAUNE - FRANCE
 
（In the case that the name and address provided above differ from those given on the label of the wine imported into Taiwan, this document of Self-Certification will be disallowed.） 	
2. Product List：        Description of Grape Wine： 
（Brand Name）         （Alcohol Content, Specification, Growing Area, Country etc.）
 
(1) Clos Vougeot Grand Cru 2009, 13% by vol.
(2) Echezeaux Grand Cru 2009, 13% by vol.
(3) Chambolle Musigny 2009, 13% by vol.
(4) Vosne Romanée Aux Réas 2009, 13% by vol.
(5) 	

	3. Certification-  I certify that the grape wine(s) described in under Item 2 above conform(s) to the Taiwan standards of hygiene with a maximumlevel of Total Sulphur Dioxide of 400 mg/L. 

 Name and Address of Certifying Entity(Producer/Trader)： 
 SARL François PARENT
14 bis rue Pierre Joigneaux
21200 BEAUNE - FRANCE
 Authorized Signature： 

 Name （Print or type）： François PARENT

 Date （DD/MM/YY）： 26/10/2011
 	
Signatures and stamps must be in a different color from that of the text  
本項進口葡萄酒之自我證明文件，僅供菸酒主管機關（財政部）辦理進口酒類查驗之用。 
This Self-Certification of Grape Wine Imported into Taiwan is for the application of inspection of imported alcohol to the competent authority(Ministry of Finance) only.