Сертификат о происхождении товара (англ.). Форма № 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 ¦ ------------------------------------------+------------------------------------
Источник - Распоряжение Правительства РФ от 06.03.2012 № 332-р
Похожие документы
- Сертификат о происхождении товара. Форма № СТ-1 (образец заполнения)
- Сертификат о происхождении товара. Форма № СТ-1
- Сертификат качества муки, хлебобулочных и макаронных изделий (quality certificate for flour, Bakery products, pasta) (рус./англ.)
- Сертификат о прохождении государственного тестирования по русскому языку (образец)
- Сертификат о происхождении товара (рус./англ.). Форма № СТ-2
