DECLARATION OF ORIGIN

Exporter Pages
1 of 1

Export Invoice Number & Date Letter Of Credit No

06 Jul 2022

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 Description of Goods Tariff Code Gross Weight
Packages (Kg)

Declaration By The Exporter

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 were produced/manufactured at

Place and Date of Issue

Signatory Company

Name of Authorized Signatory

Signature