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B o x 1 : S t a t e t h e f u l l l e g a l n a m e , a d d r e s s ( i n c l u d i n g c o u n t r y ) o f t h e e x p o r t e r .
B o x 2 : S t a t e t h e f u l l l e g a l n a m e , a d d r e s s ( i n c l u d i n g c o u n t r y ) o f t h e p r o d u c e r . I f m o r e t h a n o n e p r o d u c e r s g o o d i s i n c l u d e d i n t h e c e r t i f i c a t e , l i s t t h e a d d i t i o n a l p r o d u c e r s , i n c l u d i n g n a m e , a d d r e s s ( i n c l u d i n g c o u n t r y ) . I f t h e e x p o r t e r o r t h e p r o d u c e r w i s h e s t h e i n f o r m a t i o n t o b e c o n f i d e n t i a l , i t i s a c c e p t a b l e t o s t a t e A v a i l a b l e t o t h e c o m p e t e n t g o v e r n m e n t a l a u t h o r i t y u p o n r e q u e s t . I f t h e p r o d u c e r a n d t h e e x p o r t e r a r e t h e s a m e , p l e a s e c o m p l e t e f i e l d w i t h S A M E . I f t h e p r o d u c e r i s u n k n o w n , i t i s a c c e p t a b l e t o s t a t e " U N K N O W N " .
B o x 3 : S t a t e t h e f u l l l e g a l n a m e , a d d r e s s ( i n c l u d i n g c o u n t r y ) o f t h e c o n s i g n e e .
B o x 4 : C o m p l e t e t h e m e a n s o f t r a n s p o r t a n d r o u t e a n d s p e c i f y t h e d e p a r t u r e d a t e , t r a n s p o r t v e h i c l e N o . , p o r t o f l o a d i n g a n d d i s c h a r g e .
B o x 5 : T h e c u s t o m s a u t h o r i t i e s o f t h e i m p o r t i n g c o u n t r y m u s t i n d i c a t e ( " ) i n t h e r e l e v a n t b o x e s w h e t h e r o r n o t p r e f e r e n t i a l t a r i f f t r e a t m e n t i s a c c o r d e d .
B o x 6 : C u s t o m e r s O r d e r N u m b e r , L e t t e r o f C r e d i t N u m b e r , a n d e t c . m a y b e i n c l u d e d i f r e q u i r e d . I f t h e i n v o i c e i s i s s u e d b y a n o n - P a r t y o p e r a t o r , t h e n a m e , a d d r e s s o f t h e p r o d u c e r i n t h e o r i g i n a t i n g P a r t y s h a l l b e s t a t e d h e r e i n . S t a t e R e p l a c e s C . O . N & & d a t e d & & . w h e n t h e C . O . i s r e i s s u e d .
B o x 7 : S t a t e t h e i t e m n u m b e r , a n d i t e m n u m b e r s h o u l d n o t e x c e e d 2 0 .
B o x 8 : S t a t e t h e s h i p p i n g m a r k s a n d n u m b e r s o n t h e p a c k a g e s .
B o x 9 : N u m b e r a n d k i n d o f p a c k a g e s h a l l b e s p e c i f i e d . P r o v i d e a f u l l d e s c r i p t i o n o f e a c h g o o d . T h e d e s c r i p t i o n s h o u l d b e s u f f i c i e n t l y d e t a i l e d t o e n a b l e t h e p r o d u c t s t o b e i d e n t i f i e d b y t h e C u s t o m s O f f i c e r s e x a m i n i n g t h e m a n d r e l a t e i t t o t h e i n v o i c e d e s c r i p t i o n a n d t o t h e H S d e s c r i p t i o n o f t h e g o o d . I f g o o d s a r e n o t p a c k e d , s t a t e i n b u l k . W h e n t h e d e s c r i p t i o n o f t h e g o o d s i s f i n i s h e d , a d d * * * ( t h r e e s t a r s ) o r \ ( f i n i s h i n g s l a s h ) .
B o x 1 0 : F o r e a c h g o o d d e s c r i b e d i n B o x 9 , i d e n t i f y t h e H S t a r i f f c l a s s i f i c a t i o n t o s i x d i g i t s .
B o x 1 1 : I f t h e g o o d s q u a l i f y u n d e r t h e R u l e s o f O r i g i n , t h e e x p o r t e r m u s t i n d i c a t e i n B o x 1 1 o f t h i s f o r m t h e o r i g i n c r i t e r i a o n t h e b a s i s o f w h i c h h e c l a i m s t h a t h i s g o o d s q u a l i f y f o r p r e f e r e n t i a l t a r i f f t r e a t m e n t , i n t h e m a n n e r s h o w n i n t h e f o l l o w i n g t a b l e :
T h e o r i g i n c r i t e r i a o n t h e b a s i s o f w h i c h t h e e x p o r t e r c l a i m s t h a t h i s g o o d s q u a l i f y f o r p r e f e r e n t i a l t a r i f f t r e a t m e n t I n s e r t i n B o x 1 1 G o o d s w h o l l y o b t a i n e d P G e n e r a l r u l e a s e" 4 0 % r e g i o n a l v a l u e c o n t e n t R V C P r o d u c t s s p e c i f i c r u l e s P S R B o x 1 2 : G r o s s w e i g h t i n K i l o s s h o u l d b e s h o w n h e r e . O t h e r u n i t s o f m e a s u r e m e n t e . g . v o l u m e o r n u m b e r o f i t e m s w h i c h w o u l d i n d i c a t e e x a c t q u a n t i t i e s m a y b e u s e d w h e n c u s t o m a r y .
B o x 1 3 : I n v o i c e n u m b e r , d a t e o f i n v o i c e s a n d i n v o i c e d v a l u e s h o u l d b e s h o w n h e r e .
B o x 1 4 : T h e f i e l d m u s t b e c o m p l e t e d , s i g n e d a n d d a t e d b y t h e e x p o r t e r . I n s e r t t h e p l a c e , d a t e o f s i g n a t u r e .
B o x 1 5 : T h e f i e l d m u s t b e c o m p l e t e d , s i g n e d , d a t e d a n d s t a m p e d b y t h e a u t h o r i z e d p e r s o n o f t h e c e r t i f y i n g a u t h o r i t y . T h e t e l e p h o n e n u m b e r , f a x a n d a d d r e s s o f t h e c e r t i f y i n g a u t h o r i t y s h a l l b e g i v e n .
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