1. Goods consigned from (Exporter's business name, address, country)

Reference No.

CENTRALIZED SYSTEM OF PREFERENCES

CERTIFICATE OF ORIGIN
(Combined declaration and certificate)

FORM A

Issued in

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 number 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.

Certifying authority:
Bureau of Standards, Metrology and Inspection, Ministry of Economic Affairs

 

Signature of authroized officer	Issuing Date

 

12. Declaration by the exporter

The undersigned hereby declare that the above details and statements are correct that all the goods were produced in and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for good exported to

Place and date signature of authorized signatory