Mẫu Giấy chứng nhận hàng hóa không thay đổi xuất xứ phụ lục xiii ban hành – THÔNG TƯ 05/2018/TT-BCT

1. Goods consigned from (Trader's business name, address, country)

Reference No.

CERTIFICATE OF
NON-MANIPULATION

Issued in Vietnam

2. Goods consigned to (Consignee's name, address, country)

3. Country of Origin of Goods

4. Country of Final Destination

5. Discharge in Vietnam

Date of Discharge

via (Name of Vessel & Voyage No.)

6. Departure from Viet Nam

Date of Depature

via (Name of Vessel & Voyage No.)

7. Marks, numbers and kind of packages; description of goods and HS of goods (as far as known)

8. Gross weight or other quantity

9. Number and date of invoices

10. Declaration by the trader

11. Certification

The undersigned hereby declares that the goods described above were consigned to the country of final destination from Viet Nam without any alteration or manipulation and all information provided for above is true and correct.

It is hereby certified, on the basis of control carried out, that the declaration by the trader is correct.

This Certificate of Non-manipulation is issued without any prejudice or liability whatsover on our part arising from any circumstances.

___________________________

(Place and date, signature of the trader)

___________________________

(Place and date, signature and stamp of certifying authority)