| 1 Consignor - Expediteur - Expedidor | No. | ORIGINAL |
EUROPEAN COMMUNITY
COMMUNAUTE EUROPEENNE - COMUNIDAD EUROPEA
______________________________________ CERTIFICATE OF ORIGIN
CERTIFICAT D'ORIGINE - CERTIFICADO DE ORIGEN |
| 2 Consignee - Destinataire - Destinatario |
| 3 Country of Origin - Pays d'origine - Pais de origen |
| 4 Transport details - Informations relatives au transport - Datos relativos al transporte (Optional) | 5 Remarks - Remarques - Observaciones |
| 6 Item number; marks numbers, number and kind of packages; description of goods | 7 Quantity |
8 THE UNDERSIGNED AUTHORITY CERTIFIES THAT THE GOODS DESCRIBED ABOVE ORIGINATE IN THE COUNTRY SHOWN IN BOX 3
l'autorite soussignee certifie que les marchandises designees ci-dessus sont originaires du pays figurant dans la case No. 3
La autoridad infrascrita certifica que las mercancias abajo men cionadas son originarias del pais que figura en la casilla no. 3 Place and date of issue; name, signature and stamp of competent authority
Lieu et date de delivrance; designation, signature et cachet de lautorite competente
Lugar y fecha de expendicion; designacion, firma y sello de la autoridad competente |
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