Příloha č. 3
Vzor osvědčení o původu vydané ukrajinským úřadem
CERTIFICATE OF ORIGIN
+------------------------------+-----------------------------+------------------------+
| 1 Exporter (name, full | ORIGINAL | 2 No |
| address, country) | | |
| +-----------------------------+------------------------+
| | 3 Year | 4 Product group |
| | | |
| +-----------------------------+------------------------+
| | |
| | |
+------------------------------+ CERTIFICATE OF ORIGIN |
| 5 Consignee (name, full | |
| address, country) | |
| +-----------------------------+------------------------+
| | 6 Country of origin | 7 Country of |
| | | destination |
+------------------------------+-----------------------------+------------------------+
| 8 Place and date of shipment | 9 Supplementary details |
| - means of transport | |
+------------------------------+---------+-------------+---------------+--------------+
| 10 Description of goods - manufacturer | 11 CN code | 12 Quantity | 13 Fob value |
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+----------------------------------------+-------------+---------------+--------------+
| 14 CERTIFICATION BY THE COMPETENT AUTHORITY |
| |
| I, the undersigned, certify that the goods described above originated in the |
| country, in accordance with the provisions in force. |
| |
| |
| |
| |
+-------------------------+ At....................... on ......................... |
| 15 Competent authority | (Signature) (Stamp) |
| (name, full address, | |
| country) | |
| | |
| | |
| | |
+-------------------------+-----------------------------------------------------------+
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