1.

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

Reference No.

CERTIFICATE OF ORIGIN
(NON PREFERENTIAL)
(Combined Declaration and Certificate)
Issued in India

2. Goods consigned to (Consignee’s name, address, country)

DELHI CHAMBER OF COMMERCE

ESTD. 1950
49, RANI JHANSI ROAD, NEW DELHI-110055
PH. : 23616421, 23515828, 23518994, 23610397
FAX : 91-11-23628847, 23622815
E-Mail : info@delhichamber.com
Website : www.delhichamber.com
3. Means of transport and route (as far as known) 4. For official use

5. Item 6. Marks and 7. Number and Kind of packages, 8. Origin criteria 9. Gross weight 10. Number and date
No. number of Description of goods or other of Invoices
packages Quantity

11. Certification 12. Declaration by the exporter

It is hereby certified, on the basis of control carried out, The undersigned hereby declares that the above details
that the declaration by the exporter is correct. 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)

DELHI CHAMBER OF COMMERCE ..............................................................................................

NEW DELHI, INDIA Place, Date & Signature and stamp of authorised signatory