Chứng thư xuất khẩu mẫu số 02 phụ lục iii ban hành - THÔNG TƯ 07/2019/TT-BCT
Hướng dẫn sử dụng biểu mẫu
Nội dung biểu mẫu
Mẫu số 02 - Phụ lục III
CERTIFICATE OF ELIGIBILITY
| 
 Certificate number: (For certificate issuing authority)  | 
 Pages: /  | 
| 
 1. Name, Address of Exporter: 
 
  | 
 2. Name, Address of Importer or Consignee:  | 
| 
 3. Exporting Country/Region: 
  | 
 4. Means of Transport: 
  | 
| 
 5. Place of Loading:  | 
 6. Place of Destination:  | 
| 
 7. Item No.  | 
 8. Marks, numbers and kind of packages; decription of goods (including HS number of Importing Country)  | 
 9. Quantity of goods  | 
 10. Description of the material on the Short Supply List of Products used in the manufacture of the good exported  | 
| 
 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 
 
  | 
 
  | 
 
  | 
 
  | 
| 
 11. Declaration by the exporter The undersigned hereby declares that the above details and statements are correct; (Place and date, signature of authorised signatory) 
 
  | 
 12. Place and date, signature of Authorized officer and certificate isuing authority  | 
||
| 
 13. Remarks: 
  | 
|||