Příloha III
+--------------------------------------------------+-------------------------+----------------------------+
| 1. Exporter (name, full address, country) | ORIGINAL | 2. No |
| +-------------------------+----------------------------+
| | 3. Year | 4. Product group |
| | | |
| | | |
| +-------------------------+----------------------------+
| | |
| | |
| | EXPORT LICENCE |
| | |
| | |
| | (ECSC products) |
+--------------------------------------------------+ |
| 5. Consignee (name, full address, country) | |
| | |
| +-------------------------+----------------------------+
| | 6. Country of origin | 7. Country of destination |
| | | |
| | | |
| | | |
+--------------------------------------------------+-------------------------+----------------------------+
| 8. Place and date of shipment-Means of transport | 9. Supplementary details |
| | |
| | |
| | |
| | |
| | |
+--------------------------------------------------+----+--------------+-------------------+--------------+
| 10. Description of goods - Manufactures | 11. CN code | 12. Quantity (1) | 13.Fob |
| | | | Value (2) |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
+-------------------------------------------------------+--------------+-------------------+--------------+
| 14. CERTIFICATION BY THE COMPETENT AUTHORITY |
| |
| |
| |
+------------------------------------------------------+ |
| 15. Competent authority (name, full address,country) | At.......................... , on.............. |
| | |
| | |
| | |
| | ............................ |
| | (Signature) (Stamp) |
| | |
+------------------------------------------------------+--------------------------------------------------+
------------------------------------------------------------------
(1) Show net weight (kg) and also quantity in the unit prescribed where other than net weight.
(2) In the currency of the sale contract.
+--------------------------------------------------+-------------------------+----------------------------+
| 1. Exporter (name, full address, country) | COPY | 2. No |
| +-------------------------+----------------------------+
| | 3. Year | 4. Product group |
| | | |
| | | |
| +-------------------------+----------------------------+
| | |
| | |
| | EXPORT LICENCE |
| | |
| | |
| | (ECSC products) |
+--------------------------------------------------+ |
| 5. Consignee (name, full address, country) | |
| | |
| +-------------------------+----------------------------+
| | 6. Country of origin | 7. Country of destination |
| | | |
| | | |
| | | |
+--------------------------------------------------+-------------------------+----------------------------+
| 8. Place and date of shipment-Means of transport | 9. Supplementary details |
| | |
| | |
| | |
| | |
| | |
+--------------------------------------------------+----+--------------+-------------------+--------------+
| 10. Description of goods - Manufactures | 11. CN code | 12. Quantity (1) | 13.Fob |
| | | | Value (2) |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
+-------------------------------------------------------+--------------+-------------------+--------------+
| 14. CERTIFICATION BY THE COMPETENT AUTHORITY |
| |
| |
| |
+------------------------------------------------------+ |
| 15. Competent authority (name, full address,country) | At.......................... , on.............. |
| | |
| | |
| | |
| | ............................ |
| | (Signature) (Stamp) |
| | |
+------------------------------------------------------+----------------------------------------------------+
------------------------------------------------------------------
(1) Show net weight (kg) and also quantity in the unit prescribed where other than net weight.
(2) In the currency of the sale contract.
------------------------------------------------------------------