T. Goods consigned from (Exproter’s business name, address, country) 2. Goods consigned to (Consignee’s name, address, country) Certificate of Origin No. CERTIFICATE OF ORIGIN (NON PREFERENTIAL) (Combined declaration and certificate) Issued in india GUJARAT CHAMBER OF COMMERCE & INDUSTRY Shri Ambica Mill - Gujarat Chamber Building Post Box No. 4045, AHMEDABAD - 380 009, Phone Office :+91-079-26582301/2/3/4. Fax No, 079-26887992 ‘Website wwrw.gujaratchamberorg 3. Means of transport and route (as far as known) 4. For official use S. Item number | 6.Marksand |7.Numberand | 8. Origincriteria | 9. Gross weight or | 10. Number numbers of Kind of Packages} other quantity date of invoices Packages discription of goods H.S/CODE 1, Certification It is hereby ceritified, om the basis of control carried out, that the declaration by the exporter is correct. Place and date signature and stamp of Authorised signatory 72. Declaration by the exporter ‘he underane hry dlr that he above ta and steed aco tl he powers procs a nk nth hey comp wh eon rogue fer expe (Gemporting country) Place and date signature of Authorised signatory