Form E colour - MITI FTA

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ORIGINAL1. Products consigned from (Exporter s business name,address, country)2. Products consigned to (Consignee s name, address,country)3. Means of transport and route (as far as known)Departure dateVessel s name/Aircraft of DischargeReference FREE TRADE AREAPREFERENTIAL TARIFFCERTIFICATE OF ORIGIN(Combined Declaration and Certificate) form E4. For Official UsePreferential Treatment GivenPreferential Treatment Not Given (Pleasestate reason/s)5. Itemnumber11. Declaration by the exporterThe undersigned hereby declares that the abovedetails and statement are correct; that all the productswere produced in (Country)and that they comply with the origin requirementsspecified for these products in the Rules of Originfor the ACFTA for the products exported to (Importing Country)Place and date, signature ofauthorised signatory12.

ORIGINAL 1.Products consigned from (Exporter’s business name, address, country) 2.Products consigned to (Consignee’s name, address, country) 3.Means of transport and route (as far as known)

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