APPLICATION FOR CERTIFICATE OF ORIGIN (NON PREFERENTIAL)

Goods consigned from (Exporter’s business name, address, country)

IEC No.: Dated :

To
The Secretary,
DELHI CHAMBER OF COMMERCE
ESTD. 1950
49, RANI JHANSI ROAD, NEW DELHI-110055
PH. : 23616421, 23515828, 23518994, 23610397
FAX : 91-11-23628847, 23622815
Goods consigned to (Consignee’s name, address, country) E-Mail : info@delhichamber.com
Website : www.delhichamber.com
Dear Sir,

This is to request the favour of your issuing us Certificate of

Origin (in...................................................................................
...........................................................................) in respect of
the consignment particulars of which are given herewith.

Yours sincerely,
Encl.
Means of transport and route (as far as known)

Signature of Exporter

Item Marks and Number and Kind of packages, Origin criteria Gross weight Number and date
No. number of Description of goods or other of Invoices
packages Quantity

Declaration by the exporter

The undersigned hereby declares that the above details 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 & Signature and stamp of authorised signatory