Приложение 2. Форма сертификата о происхождении товара формы "A"

Приложение 2

к Положению о порядке выдачи

сертификатов о происхождении

товара формы "A"

ФОРМА СЕРТИФИКАТА О ПРОИСХОЖДЕНИИ ТОВАРА ФОРМЫ "A"

1. Goods consigned from (exporter's

business name, address, country)

Reference No

A 517951

GENERALIZED SYSTEM OF PREFERENCES

2. Goods consigned to (consignee's name,

address, country)

CERTIFICATE OF ORIGIN

(Combined declaration and certificate)

FORM A

Issued in ................

(country)

See notes overleaf

3. Means of transport and route

(as far as known)

4. For official use

5. Item

number

6. Marks and

numbers of packages

7. Number and kind of packages; description of goods

8. Origin

criterion

(see notes

overleaf)

9. Gross

weight

or other

quantity

10. Number

and date of

invoices

11. Certification

It is hereby certified, on the basis of control carried out, 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 all 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 stamp of certifying authority

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

Place and date, signature of authorized signatory