Формат бланка сертификата о происхождении товара. Форма N «А» (англ.)

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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¦

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¦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      ¦                                         ¦

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SERIE C N 151560