Формат бланка сертификата о происхождении товара. Форма № "А" (англ.)

Приложение к Письму от 6 августа 2007 г. N 06-53/29240

-------------------------------------------------------------------------------
¦1. Goods consigned from (Exporter's¦Reference N                              ¦
¦business name, address, country)   ¦                                         ¦
¦                                   ¦    GENERALISED SYSTEM OF PREFERENCES    ¦
¦                                   ¦                                         ¦
¦                                   ¦         CERTIFICATE OF ORIGIN           ¦
¦                                   ¦                                         ¦
+-----------------------------------+ (Combined declaration and certificate)  ¦
¦2. Goods consigned to (Consignee's ¦                                         ¦
¦name, address, country)            ¦                 FORM A                  ¦
¦                                   ¦                                         ¦
¦                                   ¦       Issued in _______________         ¦
¦                                   ¦                    (Country)            ¦
¦                                   ¦                                         ¦
¦                                   ¦                       See notes overleaf¦
+-----------------------------------+-----------------------------------------+
¦3. Means оf transport and route    ¦4. For official use                      ¦
¦(as for as known)                  ¦                                         ¦
¦                                   ¦                                         ¦
¦                                   ¦                                         ¦
¦                                   ¦                                         ¦
¦                                   ¦                                         ¦
+-----------------------------------+-----------------------------------------+
¦5.    ¦6. Marks ¦7. Number and kind of   ¦8. Origin  ¦9. Gross  ¦10. Number  ¦
¦Item  ¦and num- ¦packages: description   ¦criterion  ¦weight or ¦and date of ¦
¦number¦ber of   ¦of goods                ¦(see Notes ¦other     ¦invoices    ¦
¦      ¦packages ¦                        ¦overleaf)  ¦quantity  ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
¦      ¦         ¦                        ¦           ¦          ¦            ¦
+------+---------+------------------------+-----------+----------+------------+
¦11. Certification                  ¦12. Declaration by the exporter          ¦
¦It is hereby certified, on the     ¦                                         ¦
¦basis of control carried out, that ¦The undersigned hereby declares that the ¦
¦the declaration by the exporter is ¦above details and statements are correct;¦
¦correct.                           ¦that all the goods were produced in      ¦
¦                                   ¦ _______________________________________ ¦
¦                                   ¦               (country)                 ¦
¦                                   ¦and that they comply with the origin     ¦
¦                                   ¦requirements specified for those goods in¦
¦                                   ¦the Generalised System of Preferences for¦
¦                                   ¦goods exported to                        ¦
¦                                   ¦ _______________________________________ ¦
¦                                   ¦          (importing country)            ¦
¦                                   ¦ _______________________________________ ¦
¦___________________________________¦ Place and date signature of authorised  ¦
¦ Place and date signature and stamp¦ signatory                               ¦
¦      of certifying authority      ¦                                         ¦
------------------------------------+------------------------------------------

SERIE C N 151560

Источник - Письмо ФТС России от 06.08.2007 № 06-53/29240