Mẫu c/o mẫu b của việt nam phụ lục xi ban hành - THÔNG TƯ 05/2018/TT-BCT

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

Reference No.

CERTIFICATE OF ORIGIN
(Combined declaration and certificate)
FORM B
Issued in Vietnam

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

4. Competent authority (name, address, country)

3. Means of transport and route (as far as known)

5. For official use

6. Marks, numbers and kind of packages; description of goods

7. Gross weight or other quantity

8. Number and date of invoices

9. Certification

10. Declaration by the exporter

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

The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in Vietnam and that they comply with the origin requirements specified for goods exported to

_______________

(importing country)

___________________________

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

___________________________

(Place and date, signature of authority signatory)