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

Приложение 2
к Положению о порядке выдачи
сертификатов о происхождении
товара формы "А"

Форма сертификата о происхождении товара формы "А"

1. Goods consigned from (exporter's business name, address, country)			Reference No_________ A 517951 GENERALIZED SYSTEM OF PREFERENCES CERTIFICATE OF ORIGIN (Combined declaration and certificate) FORM A Issued in............................. (country) See notes overleaf
2. Goods consigned to (consignee's name, address, country)
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 ot authorized signatory