Supplier’s declaration for products having preferential origin status

The supplier’s declaration, the text of which is given below, must be made out in accordance with the footnotes. However, the footnotes do not have to be reproduced.

DECLARATION

I, the undersigned, declare that the goods listed on this document ………………(1) originate in ……………… (2) and satisfy the rules of origin governing preferential trade with ……………… (3):

I declare that (4):

• Cumulation applied with ……………… (name of the country/countries)
• No cumulation applied

I undertake to make available to the customs authorities any further supporting documents they require:

……………… (5)

……………… (6)

……………… (7)

(1) If only some of the goods listed on the document are concerned, they shall be clearly indicated or marked and this marking entered in the declaration as follows:
“……………… listed on this document and marked ……………… originate in ………………”.

(2) The European Union, country, group of countries or territory, from which the goods originate.

(3) Country, group of countries or territory concerned.

(4) To be completed, where necessary, only for goods having preferential origin status in the context of preferential trade relations with one of the countries, with which pan-Euro-Mediterranean cumulation of origin is applicable.

(5) Place and date.

(6) Name and position in the company.

(7) Signature.

Stand: 10.02.2022