1.

Exporter’s Name, Address, and Country:

Certification No.

Number of page

2.

Manufacturer’s Name,

Address, and Country:

AGREEMENT BETWEEN INDIA AND UAE

CERTIFICATE OF ORIGIN

3.

Importer’s or Consignee’s

Name, Address, and Country:

4.

Transport details

5.

Item number (as necessary); Marks and numbers; Number and kind of packages; Description of good(s); HS tariff classification number

6. ORIGIN

criterion (see overleaf note)

Cumulation

7. Gross Weight or other Quantity

8. Invoice number(s) and date(s)

9.

IS

Remarks:

SUED RETROSPECTIVELY

10. Third-Party Invoicing Name, Address, and Country

11. Declaration by the exporter:

I, the undersigned, declare that:

12. Certification

It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct.

• the above details and statement are true and accurate;
• the good(s) described above meet the condition(s) required for the issuance of this certificate; and
• the country of origin of the good(s) described above is:______ Place and Date:

Signature:

Name (printed):

Company:

Export Document Number:

Issuing Authority:

[Stamp]

Place and Date:

Signature: