Application for Certificate of Origin

Form B

The undersigned being the exporter of the goods described overleaf DECLARE that these goods were produced in _____________(Country’s Name)
Follow the grounds on which the goods are claimed to comply with GSP origin requirements)
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Submits the following Supporting Documents
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UNDERTAKES to submit, at the request of the appropriate authorities of the exporting country, any additional supporting evidence which these authorities may require for the purpose of issuing a certificate of origin and undertakes, if required, to agree to any inspection of his accounts and check on the processes of manufacture of the above goods, carried out by the said authority.

Request the issue of a certificate of origin for these goods

Place and Date___________