REPUBLIC OF IRAQ
REQUEST FOR CERTIFICATE /
  1. Trade Parties & Place of Inspection

Seller (Exporter): name and address
Telephone:
Fax:
Email:
Contact name: / Buyer (Importer): name and address
Telephone:
Fax:
Email:
Contact name:
Manufacturer / Supplier (if different from seller): name and address
Telephone:
Fax:
Email:
Contact name: / Location where goods are available for inspection:
Address:
Contact name:
Telephone: Fax:
Email:
Expected date of shipment:
Date of availability of goods:
Country of destination:
Type of delivery: Total Partial Final
Shipment method:
Air Sea Road / Consignment: FCL : x20” FCL x40”FCL
FCL could be on truck
Details: LCL: Bulk General Cargo/Conventional
trucks (size/volume: )
  1. Proforma Invoice / Contract Purchase Order

Number: / Currency:
Date: / Total Value
Incoterm: / FOB Value
  1. Information on Goods

Goods description: (Please attach list of products (proforma invoice…)
Goods conditions: New Second hand/Used Complete Complete knock down Semi knock down
  1. ICIGI Program

Goods subject to ICIGI Program:Not subject*
(*Do not fill the followings if not subject to ICIGI program)
Please provide copies of conformity documents related to the exported products (Test reports, reports of analysis, certificates…) and any other document demonstrating conformity of the exported goods to Iraqi requirements
ISO 9001 Certificate: Yes No / Other Certification :
Test Report provided: Yes No / Testing done by: Own lab Third party lab
Certificates provided: Yes No / Registration No.: Licensing No.: :
Applicable standards (if Known):
Lab information: ISO 17025 accreditation Yes No Other:
  1. Shipment Method and Points of Entry (Information on Points of Entry Is Mandatory):

Air Bagdad airport Al-Basra airport Al-Najaf airport Al-Mosul airport
Sea/river Umm Qasr port Khor Al-Zubair port Abu Floos port Al-Maaqal port
Road Bagdad Train station
Syria – Rabeaa (Mosul) Syria – Al-Waleed (Ramadi)
Jordan – Trabeel (Ramadi)
Kuwait – Safwan (Basra)
Iran – Shalamcha (Basra) Iran – Badra (Wasit) Iran – Al- Muntheryah (Diyala) Iran – Al-sheeb
Iran – Zarbatiya
The following points of entry are located in Kurdistan province :
Air Erbil airport Al-Sulaymaniyah airport
Road Turkey – Ibrahim El-Khalil
Iran – Bashmakh (Banja in) Iran – Barwizkhan Iran – Sartak Iran – Sarian Band
Iran – Tawella Iran – Kelle Iran – Hajj Omran
Other point of entry - please specify:
  1. Affidavit of the Applicant

I hereby declare thatthe above information and all supporting documentsare true and complete in every respect. I undertake to only ship to Iraq goods (i) specifically identified in the certificate issued by Bureau Veritas (description, brand/manufacturer name, quantity and, as applicable, productions-expiry dates, batch number) and (ii) compliantand consistent with the conformity documents I provided. I hereby authorize Bureau Veritas to discloseto the authorities any and all information regarding my Request for Certificate.
Applicant name:
Company:
Signature:
Date: / Title:
If different from above:
Email:
telephone:

Bureau Veritasisavailable to provide additional information regardingthe ICIGI Program for the Republic of Iraq.If you have any comments/complaints/appeals regarding our services, please notify us at:.

This Request for Certificate is expressly subject to all applicable COSQC – KSQCA (as the case may be) regulations and requirementsand to the Bureau Veritas General Conditions of Services which are available upon request sent to:.

IQ – REQUEST FOR CERTIFICATE FORM
Edition: 1.5 / 1/1