Format For Certificate of Origin

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1. Goods Consigned from (Exporter’s business, Ref. No.

& Date_______________________________________
name, address, country)
CERTIFICATE OF ORIGIN
(NON PREFERENTIAL)
(Combined declaration and certificate)
issued in India
2. Goods Consigned to (Consignee’s name,
address, Country)

CHEMEXCIL
BASIC CHEMICALS, PHARMACEUTICALS AND COSMETICS EXPORT
PROMOTION COUNCIL
(Set up by Ministry of Commerce & Industry, Government of India)
Th
Jhansi Castle, 4 Floor, 7, Cooperage Road, Mumbai – 400001.
Tel.: 022-2202 1288, 2282 5861, 2202 1330 Fax: 022 2202 6684
Email: [email protected] : Website: www.chemexcil.in

3. Means of transport and route (as far as known) 4. For Official Use

5. Item Number 6. Marks 7. Number and 8. Origin 9. Gross 10. Number and date of invoices
and kind of packages criteria weight or
number description of other quantity
of goods
packages
H.S.CODE No.

11. Certification 12. Declaration by the exporter


It is hereby certified, on the basis of control carried The undersigned hereby declares that the above details and
out, that the declaration by the exporter is correct. statements are correct; that all goods were produced in India and
that they comply with the origin requirements for exports
to……………………………………………….. (importing country)

…………………………………………. ..Place and date


…………………………………Place and date
Signature of authorized signatory
Signature and stamp of authorized signatory.

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