ORIGINAL
1. Goodsconsignedfrom(Exporter''sbusinessname,address,country) ReferenceNo. XXXXXXCO.,LTD.
Room2901,HuaRongMansion,GuanJiaQiao85#,Shanghai200005,P.R.China
TEL:021-4711363FAX:021-4691619 GENERALIZEDSYSTEMOFPREFERENCES
CERTIFICATEOFORIGIN
(Combineddeclarationandcertificate) 2. Goodsconsignedto(Consignee''sname,address,country) FORMA SAMANAL-ABDULKARIMANDPARTNERSCO.
POB13552,RIYADH44166,KSA
TEL:4577301/4577312/4577313FAX:4577461 Issuedin THEPEOPLE''SREPUBLICOFCHINA (country) SeeNotesoverleaf 3 Meansoftransportandroute(asfarasknown) 4. Forofficialuse SHIPMENTFROMTIANJINPORTTODAMMAMPORTBYSEA 5. Itemnum-
ber
6. Marksand
numbersof
packages
7. Numberandkindofpackages;descriptionofgoods
8. Origin
criterion
(seeNotes
overleaf)
9. Gross
weight
orother
quantity
10. Number
anddateof
invoices
1
N/M
CANNEDAPPLEJAM
24TINSX340GMS
P
2200CARTONS
DS2001INV205
May22,2001
2
CANNEDSTRAWBERRYJAM
24TINSX340GMS
P
2200CARTONS
SAYTOTAL:FOURTHOUSANDFOURHUNDREDCARTONSONLY.
11. Certification
Itisherebycertified,onthebasisofcontrolcarriedout,thatthedeclarationbytheexporteriscorrect. 12. Declarationbytheexporter
Theundersignedherebydeclaresthattheabovedetailsandstatementsarecorrect,thatallthegoodswere producedin CHINA (country) andthattheycomplywiththeoriginrequirementsspecifiedforthosegoodsintheGeneralizedSystemofPreferencesforgoodsexportedto SAUDIARABIA SHANGHAI,CHINAMay22,2001 ----------------------------------------------------------------------------------------------------------
Placeanddate,signatureandstampofcertifyingauthority ----------------------------------------------------------------------------------------------------------
Placeanddate,signatureandstampofauthorizedsignatory
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