CERTIFICATE OF ORIGIN

Exporter Pages
1 of 1

Export Invoice Number & Date Letter Of Credit No

Consignee Buyer (If not Consignee)

Method of Dispatch Type of Shipment

Vessel / Aircraft Voyage No

Port of Loading Date of Departure

Port of Discharge Final Destination

Marks & Numbers Kind & No of Packages Description of Goods Tarif Code Gross Weight (kg)

Declaration By The Chamber Declaration By The Exporter

The undersigned certifies on the basis of information provided by the
exporter that to the best of it’s knowledge and belief, the goods are of
designated origin, production or manufacture.
I, the undersigned, being duly authorized by the Consignor, and having
made the necessary enquiries hereby certify that based on the rules of
origin of the country of destination, all the goods listed originate in the
country and place of designated. I further declare that I will furnish to the
Customs authorities of the importing or their nominee, for inspection at any
time, such as evidence as may be required for the purpose of verifying this
certificate.

The goods where produced/manufactured at

Place and Date of Issue Place and Date of Issue

Signatory Company Signatory Company

Name of Authorized Signatory Name of Authorized Signatory

Signature Signature