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SAMPLE CERTIFICATE OF ORIGIN

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..... icial use 4. Means of transport and route: 5. Tariff item number: 6.Marks and number of Packages: 7. Number and kind of packages/description of goods: 8. Origin criterion (see notes overleaf) 9. Gross weight or other quantity: 10. Number and date of invoices: 11. Declaration by the exporter : The undersigned hereby declares that the above details and statements are correct: that all the goods were produced in ......................... . (Country) and that they comply with the origin requirements specified for these goods in the Asia-Pacific Trade Agreement for goods expor .....

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..... n the invoice. For third party trade, the words To Order may be typed. Box 3 For Official Use Reserved for use by certifying authority. Box 4 Means of Transport and Route State in detail the means of transport and route for the products exported. If the L/C terms etc. do not require such details, type By Air or By Sea. If the products are transported through a third country this can be indicated as follows: e.g. By Air Laos to India via Bangkok Box 5 Tariff Item Number Type the 1 [ 6-digit HS heading ] of the individual items. Box 6 Marks and Numbers of Packages Type the marks and numbers of the packages covered by the Certificate. This information should be id .....

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..... .b. value of the exported product; (example C 60 per cent); 3. Enter letter D in Box 8 for products, which meet the special origin criteria according to Rule 11; 4. Enter letter E in Box 8 for products which meet the origin criteria according to sub-rule (b) of rule 4. Entry of letter E would be followed by the criteria of the rules of origin (example E CTH). ] Box 9 Gross Weight or Other Quantity Type the gross weight or other quantity (such as pieces, kg) of the products covered by the Certificate. Box 10 Number and Date of Invoices State number and date of the invoice in question. The date of the invoice attached to the Application should not be later than the date of approval on the Certificat .....

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