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Приложение 3. Certificate of Origin

Приложение 3

1. Exporter (name, address, country)

ORIGINAL N

4169792

2. Consignee (name, address, country)

CERTIFICATE OF ORIGIN

Issued in the Russian Federation

3. Means of transport and route

4. For official use

5. Country of origin

6. Supplementary details

7. Item

number

8. Description of goods

9. Number and

kind of packages

10. Gross weight

or other quantity

11. Certification

It is hereby certified, that the declaration by the exporter is correct

12. Declaration by the exporter

The undersigned hereby declares that the above details and statements are correct; that the goods are of origin of the country shown in box No 5; that the goods are exported to ...........................................................

(importing country)

........................................................................

Place, date, signature, name

and stamp of certifying authority

....................................................................

Place, date, stamp and signature

of authorized signatory