(Period:from………to……… )
The exporter of the products covered by this document (Exporter Reference No ……..) declares that, except where otherwise clearly indicated, these products are of ...………
preferential origin.
(Origin criteria used)
………...
(Place and date)
………...
(Printed name of the exporter)
………...
How to make out a “Statement on Origin” made out by the “exporter”
Period for multiple shipments of identical goods (within 12 months).
EU: REX Number
Japan: Corporate Number
(where not assigned, this field may be left blank.)
Make out the following one or more codes
“A”: Wholly obtained or produced products (WO)
“B”: Products produced exclusively from originating materials (PE)
“C”: Products produced using non-originating materials provided they satisfy the applicable PSR, with the following additional codes -”1”: Change of Tariff Classification rule (CTC)
-”2”: Value-Added/Regional value Content rule (RVC/MaxNOM) -”3”: Specific Processing rule (SP)
“D”: Accumulation
“E”: Tolerance Place and date may be omitted
if the information is contained on the document itself.
Apart from English, official languages of the EU and Japanese can be used for making out the statement