ORIGINAL
1. Goodsconsignedfrom(Exporter''sbusinessname,address,country) ReferenceNo. GENERALIZEDSYSTEMOFPREFERENCES
CERTIFICATEOFORIGIN
(Combineddeclarationandcertificate) 2. Goodsconsignedto(Consignee''sname,address,country) FORMA Issuedin THEPEOPLE''SREPUBLICOFCHINA (country) SeeNotesoverleaf 3 Meansoftransportandroute(asfarasknown) 4. Forofficialuse 5. Itemnum-
ber
6. Marksand
numbersof
packages
7. Numberandkindofpackages;descriptionofgoods
8. Origin
criterion
(seeNotes
overleaf)
9. Gross
weight
orother
quantity
10. Number
anddateof
invoices
11. Certification
Itisherebycertified,onthebasisofcontrolcarriedout,thatthedeclarationbytheexporteriscorrect. 12. Declarationbytheexporter
Theundersignedherebydeclaresthattheabovedetailsandstatementsarecorrect,thatallthegoodswere producedin CHINA (country) andthattheycomplywiththeoriginrequirementsspecifiedforthosegoodsintheGeneralizedSystemofPreferencesforgoodsexportedto ----------------------------------------------------------------------------------------------------------
Placeanddate,signatureandstampofcertifyingauthority ----------------------------------------------------------------------------------------------------------
Placeanddate,signatureandstampofauthorizedsignatory
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