Customs value of Non-originating materials, Parts or Produce _______ |
+ |
Value of Undetermined Origin Materials, Parts or Produce ________ |
x 100%_< 60% |
FOB value of the final product |
Serial Number: | ||||
1. Exporter (name, full address, Country) ID No. | 2. 2.Producer ( name, full address, Country) ID No | |||
3.Importer (name, full address, country) | 4. Observations | |||
5. Port of Shipment | 6. Country of origin | |||
7.Description of Goods (1); Marks and numbers; Number and kind of packages (2). | [8. HS Number (Six Digit Code)] | 9. Gross mass (kg) or other measure (liters, m³, etc.) | 10.Origin Criterion (3) | 11 .Invoices (N° and date and Value) |
12. COMPETENT GOVERNMENTAL AUTHORITY ENDORSEMENT Declaration certified Competent governmental office: .. Issuing country: Stamp. Place and date ... ............................................................... (Signature) |
13. DECLARATION BY THE EXPORTER I certify that: · The information on this document is true and accurate and I assume the responsibility for providing such representations. I understand that I am liable for any false statements or material omission made on or in connection with this document. · I agree to maintain and present upon request, documentation necessary to support this certificate, and to inform, in writing, all persons to whom the certificate was given of any changes that could affect the accuracy or validity of this certificate. · The goods originated in the territory of the Parties, and comply with the origin requirements specified for those goods in Chile-India PREFERENTIAL TRADE AGREEMENT, and there has been no further production or any other operation outside the territories of the Parties in accordance with Section II Rule 3 No 1 of the Agreement. Place and Date -------------------- ----------------------------------- (Signature) |
1. Producer Individual's name or company name (name,
full address, country) ID No. |
|||
2. Observations | 3. Country of Origin | ||
4. Description of Goods, Marks and numbers; Number and kind of packages. (ref (1) and(2) of notes below | 5. HS Number (Six Digit Code)] | 6. Gross mass (kg) or other measure (liters, m³, etc.) | 7. Preference Criterion (s.no.3 of notes below) 8. Invoice (No. and Date) (if known) |
DECLARATION BY THE PRODUCER I, the undersigned, producer of the goods described overleaf, DECLARE that the above goods are originating and meet the origin requirements established in this Agreement. UNDERTAKE to submit, at the request of the appropriate authorities, any supporting evidence which these authorities may require for the purpose of issuing a certificate of origin, and undertake, if required, to agree to any inspection of my accounts and to any check on the processes of manufacture of the above goods, carried out by the said authorities; REQUEST the issue of a certificate of origin for these goods.
(Signature) |
(S.P.RAO)
Under Secretary to the Government of India
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