PHARMACEUTICALS EXPORT PROMOTION COUNCIL OF INDIA

(Setup by Ministry of Commerce & Industry, Govt. of India)

Regd.1 Head Office: 101, Aditya Trade Center, Ameerpet, Hyderabad - 500016, India
Ph: +91-40-23735462/66 Fax: +91-40-23735464
E-Mail: info@pharmexcil.com Website: www.pharmexcil.com

1. Goods Consigned from Reference No.

(exporter's business name, address, country)
PHARMEXCIL I COOl

CERTIFICATE OF ORIGIN

(NON PREFERENTIAL)

(Combined declaration and cetificates)

2. Goods Consigned to
issued in India

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(Consignee's name, address, country)
I
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3. Means of transport and route

Co
4. For office use
(as for as known)
en

9. Gross
5. Item No. 6. Marks and 7. Number and kind of 8. Origin 10. Number and
weight or
number of packages packages, description of goods criteria date of invoice
otherquan~
im
ec
Sp

11. Certification 12. Declaration by the exporter

It is hereby certified, on the basis of contract
carried out, that the declaration by the
exporter is correct
The undersigned hereby declares that the
above and statements are correct.
That all the goods were produced in India
and that they comply with the origin
requirements for exports to

(Importing Country)
Place & Date Place & Date

Signature and Stamp of Authorized Signatory Stamp of Authorized Signatory