ORIGINAL 1. Goods consigned from (Exporter's business name, address, country) Reference No. GENERALIZED SYSTEM OF PREFERENCES CERTIFICATE OF ORIGIN (Combined declaration and certificate) 2. Goods consigned to (Consignee's name, address, country) FORM A Issued in THE PEOPLE'S REPUBLIC OF CHINA (country) See Notes overleaf 3 Means of transport and route (as far as known) 4. For official use 5. Item num- ber 6. Marks and numbers of packages 7. Number and kind of packages; description of goods 8. Origin criterion (see Notes overleaf) 9. Gross weight or other quantity 10. Number and date of invoices
11. Certification It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. 12. Declaration by the exporter The undersigned hereby declares that the above details and statements are correct, that all the goods were produced in CHINA (country) and that ply with the origin requirements spec
