| ||||||||||||
6. N | 7. Number and kind of packages | 8. Description of goods | 9. Quantity of goods | |||||||||
10. Certification | 11. Declaration by the applicant | |||||||||||
It is hereby certified, on the basis of control carried out, that the declaration by the applicant is correct | The undersigned hereby declares at the above details are correct, that all goods are originating in | |||||||||||
(country) | ||||||||||||
and comply with the origin requirements specified for those goods | ||||||||||||
Signature | Date | Stamp | Signature | Date | Stamp | |||||||