1. Exporter (Name & Address)
REPUBLIC OF SINGAPORE

CERTIFICATE OF ORIGIN

NO UNAUTHORISED ADDITION/ALTERATION MAY BE MADE TO THIS CERTIFICATE ONCE IT IS ISSUED
2. Consignee (Name, Full Address & Country)

8. DECLARATION BY THE Exporter
We hereby declare that the details and statements provided in this Certificate are true and correct.

Signature:
Name:
Designation:
Date:
4. Vessel’s Name/Flight No.
5. Port of Discharge
6. Country of Final Destination
7. Country of Origin of Goods

9. Marks & Numbers

10. No. & Kind of Package
Description of Goods
(include brand names if necessary)

11. H.S. Code

12. Quantity & Unit

12. CERTIFICATION BY THE COMPLEMENT AUTHORITY
We hereby certify that evidance has been produced to satisfy us that the goods specified above originate in/were processed in the country shown in box 7. This Certificate is therefore issued and certified to the best of our knowledge and belief to be correct and without any liability on our part.

Serial No:
Date: