CERTIFICATE OF ORIGIN

(Non Preferential)
Combined declaration and Certificate issued in India
Exporter
No. _____________________

Chamber of Commerce & Industry

Recognized by Ministry of Commerce & Industry
Govt. of India

Consignee

Federation of Indian Micro and Small

& Medium Enterprises
Pre-Carriage by

Place of Receipt by Pre-Carrier

Vessel / Flight No.

Port of Loading

Port of Discharge

Final Destination

Marks & Nos./ Container No.

No. & Kind of Pkgs.

CERTIFICATION
It is hereby certified that to the best of our knowledge and belief the
above mentioned goods are of Indian origin.

B-4/161, Safdarjung Enclave, New Delhi 110029

Tel.: 26187948, 26712064, 46023157, 46018592
Fax: (+91-11- ) 26109470
E-mail: chamber@fisme.org.in, info@fisme.org.in
Website: www.fisme.org.in

Description of Goods

Quantity

Invoice No. & Date

Exporter Declaration
The undersigned declares that the above details and statements
are correct, that all the goods were produced in India.

Place :
Date :
Federation of Indian Micro and Small & Medium Enterprises
New Delhi

Signature & Stamp of

Exporter / Authorised Signatory