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| 1 Consignor - Expediteur - Expedidor | No. | ORIGINAL |
EUROPEAN COMMUNITY CERTIFICATE OF ORIGIN | ||
| 2 Consignee - Destinataire - Destinatario | ||
| 3 Country of Origin - Pays d'origine - Pais de origen | ||
| 4 Transport details - Informations relatives au transport - Datos relativos al transporte (Optional) | 5 Remarks - Remarques - Observaciones | |
| 6 Item number; marks numbers, number and kind of packages; description of goods | 7 Quantity | |
8 THE UNDERSIGNED AUTHORITY CERTIFIES THAT THE GOODS DESCRIBED ABOVE ORIGINATE IN THE COUNTRY SHOWN IN BOX 3
Place and date of issue; name, signature and stamp of competent authority | ||
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