Certificate of Origin

Parties Information

Exporter

Consignee

Buyer (If not Consignee)

Method of Dispatch

Type of Shipment

Sea Freight

Air Freight

Land Transport

Other

Vessel / Aircraft

Voyage No / Flight No

Port of Loading

Date of Departure

Port of Discharge

Final Destination

Goods Details

Marks & Numbers	Kind & No of Packages	Description of Goods	Tariff Code	Gross Weight (Kg)	Action

Total Weight (Kg):

Declarations

Declaration By The Chamber

The undersigned certifies on the basis of information provided by the exporter that to the best of its knowledge and belief, the goods are of designated origin, production or manufacture.

The goods were produced/manufactured at

Place and Date of Issue (Chamber)

Signatory Company (Chamber)

Signature of Authorized Chamber Signatory

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Declaration By The Exporter

I, the undersigned, being duly authorized by the Consignor, and having made the necessary enquiries hereby certify that based on the rules of origin of the country of destination, all the goods listed originate in the country and place of designated. I further declare that I will furnish to the Customs authorities of the importing or their nominee, for inspection at any time, such as evidence as may be required for the purpose of verifying this certificate.

Place and Date of Issue (Exporter)

Signatory Company (Exporter)

Signature of Authorized Exporter Signatory

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CERTIFICATE OF ORIGIN

Declaration By The Chamber

Declaration By The Exporter