Сертификат о происхождении товара (англ.). Форма N А________________________________________________________________________________Приложение N 1 к Правилам определения происхождения товаров из развивающихся и наименее развитых стран - пользователей единой системы тарифных преференций Таможенного союза
-------------------------------------------------------------------------------¦1. Goods consigned from (exporter's ¦Reference N ¦¦ business name, address, country) ¦ ¦¦ ¦ GENERALIZED SYSTEM OF PREFERENCES ¦¦ ¦ CERTIFICATE OF ORIGIN ¦¦ ¦ (Combined declaration and ¦+-----------------------------------------+ certificate) ¦¦2. Goods consigned to (consignee's name, ¦ FORM A ¦¦ address, country) ¦ ¦¦ ¦Issued in .........................¦¦ ¦ (country) ¦¦ ¦ ¦¦ ¦ See notes overleaf¦+-----------------------------------------+-----------------------------------+¦3. Means of transport and route (as far ¦4. For official use ¦¦ as known) ¦ ¦+-----------------------------------------+-----------------------------------+¦5. Item¦6. Marks and ¦7. Number and ¦8. Origin ¦9. Gross ¦10. Number and¦¦ num-¦ numbers of¦ kind of ¦ criterion ¦ weight ¦ date of ¦¦ ber ¦ packages ¦ packages; ¦ (see notes¦ or other¦ invoices ¦¦ ¦ ¦ description¦ overleaf) ¦ quantity¦ ¦¦ ¦ ¦ of goods ¦ ¦ ¦ ¦+-------+-------------+--------------+-------------+-----------+--------------+¦11. Certification ¦12. Declaration by the exporter ¦¦ ¦ ¦¦It is hereby certified, on the basis of ¦The undersigned hereby declares ¦¦control carried out, that the declaration¦that the above details and ¦¦by the exporter is correct. ¦statements are correct, that all ¦¦ ¦the goods were produced in ¦¦ ¦...................................¦¦ ¦ (country) ¦¦ ¦ ¦¦ ¦and that they comply with the ¦¦ ¦origin reguiremeats specified for ¦¦ ¦those goods in the Generalized ¦¦ ¦System of Preferences for goods ¦¦ ¦exported to ¦¦ ¦...................................¦¦ ¦ (importing country) ¦¦ ¦ ¦¦.........................................¦...................................¦¦Place and date, signature sad stamp ¦Place and date, signature of ¦¦of certifying authority ¦authorized signatory ¦-----------------------------------------+------------------------------------------------------------------------------------------------------------------¦1. Expediteur (nom, adresse, pays de ¦Reference N ¦¦l'exportateur) ¦ ¦¦ ¦SYSTEME GENERALIZE DE PREFERENCES ¦¦ ¦ CERTIFICAT D'ORIGINE ¦¦ ¦ (Declaration et certificat) ¦+-----------------------------------------+ ¦¦2. Destinataire (nom, adresse, pays) ¦ FORMULE A ¦¦ ¦ ¦¦ ¦Delivre en ........................¦¦ ¦ (pays) ¦¦ ¦ ¦¦ ¦ Voir notes au verso¦+-----------------------------------------+-----------------------------------+¦3. Moyen de transport et itineraire ¦4. Pour usage officiel ¦¦ (si connus) ¦ ¦+----------------------------------------T+-----------------------------------+¦5. N ¦6. Margues et¦7. Numbre et type¦8. Critere ¦9. Poids ¦10. N et ¦¦ d'or-¦ numeros ¦ de colis; ¦ d'origine¦ brut ou ¦ date ¦¦ dre ¦ des colis ¦ description ¦ (voir ¦ guantity¦ de la ¦¦ ¦ ¦ des ¦ notes ¦ ¦ facture¦¦ ¦ ¦ marchandises ¦ au verso)¦ ¦ ¦+--------+-------------+-----------------+T-----------+-----------+-----------+¦11. Certificat ¦12. Declaration de l'exportateur ¦¦ ¦ ¦¦ll est certifie, sur la base du controle ¦Le soussigne declare que les ¦¦effectue, que la declaration de ¦mentions et indications ci-dessus ¦¦l'exportateur est exacte. ¦sont exactes, que toutes ces ¦¦ ¦marchandises ont ete produites en ¦¦ ¦...................................¦¦ ¦ (nom du pays) ¦¦ ¦ ¦¦ ¦et qu'elles remplissent les ¦¦ ¦conditions d'origine requises par ¦¦ ¦le systeme generalise de preferen- ¦¦ ¦ces pour etre exportees a destina- ¦¦ ¦tion de ¦¦ ¦...................................¦¦ ¦ (nom du pays importateur) ¦¦ ¦ ¦¦.........................................¦...................................¦¦Lieu et date, signature et timbre de ¦Lieu et date, signature du ¦¦l'autorite delivrant le certificat ¦signataire habilite ¦-----------------------------------------+------------------------------------
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