Declaration of origin

I, the undersigned, duly authorized by …………………………………………………………………………..(insert name of supplier), certify that the goods described above originate in the country shown in column 5 in accordance with the requirements of paragraph *1 / *2 (*delete whichever is not applicable and sign in full).

*1. The goods enumerated opposite item(s) ……………………………………………… in column 1 above have been wholly produced or manufactured in the country stated in column 5 in respect of such goods from raw materials produced in that country.
*2. The goods enumerated opposite item(s) ………………………………………………. in column 1 above have been wholly or partly manufactured from imported materials in the country specified in column 5 of such goods; and

(a) the final process of manufacture has taken place in the said country;

(b) the cost to the manufacturer of the materials wholly produced or manufactured in the said country plus the cost of labour directly employed in the manufacture of such goods is not less than ……….. per cent of the total production cost of such goods;

(c) in calculating the production cost of such goods only the cost to the manufacturer of all materials, wages and salaries, direct manufacturing expenses, overhead factory expenses, cost of inside containers and other expenses used or expended in the manufacture of such goods have been included and charges for outside packages, profits and administrative, distribution and selling overhead expenses, and other charges incurred subsequent to the completion of the manufactured goods, have been excluded.

Place of issue

………………………………………………………….

Full name and capacity (print)

Date

Signature