4. Форма дополнительного листа сертификата о происхождении товара на английском языке

4. Форма дополнительного листа сертификата о происхождении

товара на английском языке

ADDITIONAL SHEET OF CERTIFICATE OF ORIGIN N ____________
6. N	7. Number and kind of packages		8. Description of goods			9. Quantity of goods

10. Certification					11. Declaration by the applicant
It is hereby certified, on the basis of control carried out, that the declaration by the applicant is correct					The undersigned hereby declares that the above details are correct, that all goods are originating in ____________________________________ (country)
					and comply with the origin requirements specified for those goods

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Signature		Date		Stamp	Signature	Date	Stamp