Приложение 3. Certificate of Origin

Приложение 3

1. Exporter (name, address, country)		ORIGINAL N
		4169792
2. Consignee (name, address, country)		CERTIFICATE OF ORIGIN Issued in the Russian Federation

3. Means of transport and route		4. For official use

5. Country of origin		6. Supplementary details

7. Item number	8. Description of goods		9. Number and kind of packages	10. Gross weight or other quantity

11. Certification It is hereby certified, 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 the goods are of origin of the country shown in box No 5; that the goods are exported to ........................................................... (importing country)
........................................................................ Place, date, signature, name and stamp of certifying authority		.................................................................... Place, date, stamp and signature of authorized signatory