Формат бланка сертификата о происхождении товара. Форма N "А" (англ.)
Приложение к Письму от 6 августа 2007 г. N 06-53/29240
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¦1. Goods consigned from (Exporter's¦Reference N ¦
¦business name, address, country) ¦ ¦
¦ ¦ GENERALISED SYSTEM OF PREFERENCES ¦
¦ ¦ ¦
¦ ¦ CERTIFICATE OF ORIGIN ¦
¦ ¦ ¦
+-----------------------------------+ (Combined declaration and certificate) ¦
¦2. Goods consigned to (Consignee's ¦ ¦
¦name, address, country) ¦ FORM A ¦
¦ ¦ ¦
¦ ¦ Issued in _______________ ¦
¦ ¦ (Country) ¦
¦ ¦ ¦
¦ ¦ See notes overleaf¦
+-----------------------------------+-----------------------------------------+
¦3. Means оf transport and route ¦4. For official use ¦
¦(as for as known) ¦ ¦
¦ ¦ ¦
¦ ¦ ¦
¦ ¦ ¦
¦ ¦ ¦
+------T---------T------------------+-----T-----------T----------T------------+
¦5. ¦6. Marks ¦7. Number and kind of ¦8. Origin ¦9. Gross ¦10. Number ¦
¦Item ¦and num- ¦packages: description ¦criterion ¦weight or ¦and date of ¦
¦number¦ber of ¦of goods ¦(see Notes ¦other ¦invoices ¦
¦ ¦packages ¦ ¦overleaf) ¦quantity ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
¦ ¦ ¦ ¦ ¦ ¦ ¦
+------+---------+------------------T-----+-----------+----------+------------+
¦11. Certification ¦12. Declaration by the exporter ¦
¦It is hereby certified, on the ¦ ¦
¦basis of control carried out, that ¦The undersigned hereby declares that the ¦
¦the declaration by the exporter is ¦above details and statements are correct;¦
¦correct. ¦that all the goods were produced in ¦
¦ ¦ _______________________________________ ¦
¦ ¦ (country) ¦
¦ ¦and that they comply with the origin ¦
¦ ¦requirements specified for those goods in¦
¦ ¦the Generalised System of Preferences for¦
¦ ¦goods exported to ¦
¦ ¦ _______________________________________ ¦
¦ ¦ (importing country) ¦
¦ ¦ _______________________________________ ¦
¦___________________________________¦ Place and date signature of authorised ¦
¦ Place and date signature and stamp¦ signatory ¦
¦ of certifying authority ¦ ¦
L-----------------------------------+------------------------------------------
SERIE C N 151560
