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┌───────────────────────────────────┬───────────────────────────────────────┐

│1. Goods consigned from (exporter's│Reference No A 626502│

│business name, address, country) │ │

│ │ GENERALIZED SYSTEM OF PREFERENCES │

│ │ │

│ │ CERTIFICATE OF ORIGIN │

│ │(Combined declaration and certificate) │

├───────────────────────────────────┤ │

│2. Goods consigned to (consignee's │ FORM A │

│name, address, country) │ │

│ │Issued in __________________________ │

│ │ (country) │

│ │ │

│ │ See notes overleaf │

├───────────────────────────────────┼───────────────────────────────────────┤

│3. Means of transport and route (as│4. For official use │

│far as known) │ │

│ │ │

│ │ │

│ │ │

│ │ │

│ │ │

├───────┬────────────┬──────────────┴─┬────────────┬───────────┬────────────┤

│5. Item│6. Marks and│7. Number and │8. Origin │9. Gross │10. Number │

│ num-│ numbers │ kind of │ criterion│ weight │ and date│

│ ber │ of │ packages; │ (see │ or │ of │

│ │ packages │ description │ notes │ other │ invoices│

│ │ │ of goods │ overleaf)│ quantity│ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

│ │ │ │ │ │ │

├───────┴────────────┴──────────────┬─┴────────────┴───────────┴────────────┤

│11. Certification │12. Declaration by the exporter │

│ It is hereby certified, on the │ The undersigned hereby declares │

│ basis of control carried out, │ that the above details and │

│ that the declaration by the │ statements are correct; that all │

│ exporter is correct. │ the goods were │

│ │ produced in ______________________ │

│ │ (country) │

│ │ and that they comply with the │

│ │ origin requirements specified for │

│ │ those goods in the generalized │

│ │ system of preferences for goods │

│ │ exported to │

│ │ _____________________________________ │

│ │ (importing country) │

│ │ │

│___________________________________│ _____________________________________ │

│Place and date, signature and │ Place and date, signature of │

│stamp of certifying authority │ authorized signatory │

└───────────────────────────────────┴───────────────────────────────────────┘

NOTES (1988)

I. Countries which accept Form A for the purposes of the

generalized system of preferences (GSP):

Australia <*> Norway European Economic Community:

Austria Sweden Belgium Ireland

Canada Switzerland Denmark Italy

Finland United States France Luxembourg

Japan of America Federal Republic of Germany Netherlands

New Zealand Greece Portugal

Spain

United Kingdom

-----------------------------------

<*> For Australia, the main requirement is the exporter's

declaration on the normal commercial invoice. Form A, accompanied

by the normal commercial invoice, is an acceptable alternative,

but official certification is not required.

People's Republic of Bulgaria

Czechoslovak Socialist Republic

Hungarian People's Republic

Polish People's Republic

Union of Soviet Socialist Republics

Full details of the conditions covering admission to the GSP in

these countries are obtainable from the designated authorities in

the exporting preference - receiving countries or from the customs

authorities of the preference - giving countries listed above. An

information note is also obtainable from the UNCTAD secretariat.

II. General conditions

To qualify for preference, products must:

(a) fall within a description of products eligible for

preference in the country of destination. The description

entered on the form must be sufficiently detailed to

enable the products to be identified by the customs

officer examining them;

(b) comply with the rules of origin of the country of

destination. Each article in a consignment must qualify

separately in its own right; and,

(c) comply with the consignment conditions specified by the

country of destination. In general, products must be

consigned direct from the country of exportation to the

country of destination but most preference - giving

countries accept passage through intermediate countries

subject to certain conditions. (For Australia, direct

consignment is not necessary.)

III. Entries to be made In Box 8

Preference products must either be wholly obtained in accordance

with the rules of the country of destination or sufficiently

worked or processed to fulfil the requirements of that country's

origin rules.

(a) Products wholly obtained: for export to all countries

listed in Section I, enter the letter "P" in Box 8 (for

Australia and New Zealand Box 8 may be left blank).

(b) Products sufficiently worked or processed: for export to

the countries specified below, the entry in Box 8 should

be as follows:

(1) United States of America: for single country

shipments, enter the letter "Y" in Box 8, for

shipments from recognized associations of countries,

enter the letter "Z", followed by the sum of the cost

or value of the domestic materials and the direct cost

of processing, expressed as a percentage of the

ex - factory price of the exported products (example

"Y" 356% or "Z" 35%).

(2) Canada: for products which meet origin criteria from

working or processing in more than one eligible least

developed country, enter letter "G" in Box 8;

otherwise "F".

(3) Austria, Finland, Japan, Norway, Sweden, Switzerland

and the European Economic Community: enter the letter

"W" in Box 8 followed by the Customs Co - operation

Council Nomenclature (harmonized System) heading of

the exported product (example "W" 96.18).

(4) Bulgaria, Czechoslovakia, Hungary, Poland and the

USSR: for products which include value added in the

exporting preference - receiving country, enter the

letter "Y" in Box 8 followed by the value of imported

materials and components expressed as a percentage

of the f.o.b. price of the exported products (example

"Y" 45%); for products obtained in a preference -

receiving country and worked or processed in one or

more other such countries, enter "Pk".

(5) Australia and New Zealand: completion of Box 8 is not

required. It is sufficient that a declaration be

properly made in Box 12.