Form A - Generalized System Of Preferences - Certificate Of Origin
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21. Goods consigned from (Exporter’s business name, address,
Reference No
country)
GENERALIZED SYSTEM OF PREFERENCES
CERTIFICATE OF ORIGIN
(Combined declaration and certificate)
FORM A
2. Goods consigned to (Consignee’s name, address, country)
Issued in ..................................................................................
(country)
See notes overleaf
3. Means of transport and route (as far as known)
4. For official use
5. Item
6. Marks and
7. Number and kind of packages, description of goods
8. Origin
9. Gross
10. Number
num-
numbers of
criterion
weight
and date
ber
packages
(see Notes
or other
of invoices
overleaf)
quantity
11. Certification
12. Declaration by the exporter
It is hereby certified, on the basis of control carried out,
The undersigned hereby declares that the above details
that the declaration by the exporter is correct.
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
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