1. Goods consigned from(exporter's business name, address, country)
Reference No
GENERALIZED SYSTEM OF
PREFERENCES CERTIFICATE
OF ORIGIN
(Combined declaration and certificate) FORM A
REPUBLEC of KOREA
Issued in
(country)
See notes overleaf
2. Goods consigned to(consignee's name, address, country)
3. Means of transport and route(as far as known)
4. For official use
5. Item
num-
ber
6. Marks and
numbers 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 in voice
11. Certification
It is hereby certified, on the
basis of control carried out, that the declaration by the exporter is correct.
..........................................................
Place and date, signature and stamp
of certifying authority
12. Declaration by the exporter
The undersigned hereby declares
that the above details and
statements are correct : that all
the goods were
produced in REPUBLIC OF KOREA
(country)
and that they comply with the
origin requirements specified for
those goods in the generalized
system of preferences for goods
exported to
................................................................
(importing country)
................................................................
plase and date, signature of
authorized signatory |
2007.12.04
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