Long-term supplier’s declaration for products having preferential origin status[1]
The supplier’s declaration, the text of which is given below, must be made out in accordance with the footnotes.
However, the footnotes do not have to be reproduced.
DECLARATION
I, the undersigned, declare that the goods described below:
………………………………………………………………………… (1)
………………………………………………………………………… (2)
which are regularly supplied to ………………….……..………. (3),
originate in ………………..(4) and satisfy the rules of origin governing preferential trade with (5):
AD / CH / TR /
AL / BA / XK (= KO) / ME / MK / XS (= RS) /
CL / MX /
DZ / EG / FO / IL / JO / LB / MA / PS / SY / TN / XC / XL /
GE / MD / UA /
KR /
ZA /
Andes ( CO / PE )
Cariforum ( AG / BB / BS / BZ / DM / DO / GD / GY / JM / KN / LC / SR / TT / VC / )
EEA ( IS / LI / NO / )
ESA (MG / MU / SC / ZW / )
Central Africa (CM /)
GSP (= LDC and OBC)* / OCT* / MAR-ACP*
Central-America ( CR / GT / HN / NI / PA / SV/ )
West Pacific (PG / FJ / )
I declare that (6):
� Cumulation applied with …………. (name of the country/countries)
� No cumulation applied
This declaration is valid for all shipments of these products dispatched
from: ……..…………. to ……….……. (7).
I undertake to inform …………………………………. (3) immediately if this declaration is no longer valid.
I undertake to make available to the customs authorities any further supporting documents they require.
Place and date : ………………………………..
Name and position : ………………………………..
Name and address of
the company : ……………………………….
Signature : ………………………………
Take over the text on the first page – after completion – on company letter paper.
(1) Description of the goods. (If possible please mention customs tariff number)
(2) Commercial designation as used on the invoices, e.g. model No.
(3) Name of the company to which goods are supplied
(4) The European Union, country, group of countries or territory from which the goods originate.
For products originating in the European Union, "European Union" must be entered. If abbreviations should be used, please use the following code: 'EU'. In addition, the specification of an EU Member State (for example, Germany or France) may take place when the goods have obtained their preferential origin status in that EU member state.
In the case of goods originating in a country with which the EU has preferential agreements (e.g., Switzerland, South Africa, etc.), this country needs to be specified. Within:
- The Pan-European cumulation zone – includes the EU Member States, Iceland (IS), Liechtenstein (LI), Norway (NO), Switzerland (CH) and Turkey (TR) or:
- The Pan-Euro-Med cumulation zone – includes the EU countries, Algeria (DZ), Egypt (EG), Faroe Islands (FO), Iceland IS), Israel (IL), Jordan (JO), Lebanon (LB), Liechtenstein (LI), Morocco (MO), Norway (NO),
West bank and Gaza Strip (PS) Switzerland (CH), Syria (SY), Tunisia (TN) and Turkey (TN) or:
- SAP cumulation (Stabilization and Association Process zone) – includes the EU member states, Albania (AL), Bosnia and Herzegovina (BA), Kosovo (KO) Macedonia (MK), Montenegro (ME), Serbia (RS) and Turkey (TR), these can also be called countries of origin.
Point of attention: As Syria did not yet sign the Pan Euro Med agreement it is not possible to fill in this country.
For actual information about cumulation please contact the Chamber of Commerce.
(5) Country, group of countries or territory concerned:
Andorra (AD), Switzerland (CH), Turkey (TR),
Albania (AL), Bosnia-Hercegovina (BA), Kosovo (XK = KO), Montenegro (ME), Macedonia (MK), Serbia (XS = RS),
Chile (CL), Mexico (MX),
Algeria DZ), Egypt (EG), Faroe Islands (FO), Israel (IL), Jordan (JO), Lebanon (LB), Morocco (MA), West Bank
and Gaza Strip (PS), Syria (SY), Tunisia (TN), Ceuta (XC), Melilla (XL),
Georgia (GE), Moldova (MD),Ukraine (UA),
Rep. of Korea (KR),
South Africa (ZA),
Andes: Colombia (CO), Peru (PE),
Cariforum: Antigua and Barbuda (AG), Bahamas (BS), Barbados (BB) , Belize (BZ), Dominica (DM),
Dominican Republic (DO), Grenada (GD), Guyana (GY), Jamaica (JM), Saint Christopher and
Nevis (KN), Saint Lucia (LC),Suriname (SR), Trinidad and Tobago (TT), Saint Vincent and the
Grenadines (VC).
EEA: Iceland (IS), Liechtenstein (LI), Norway (No).
ESA: States of Eastern and Southern Africa: Madagascar (MG), Mauritius (MU), Seychelles (SC),
Zimbabwe (ZW).
GSP*: Generalized System of Preferences – developing countries, (LDC and OBC).
OCT*: Overseas Countries an Territories of the EU member states.
MAR-ACP*: Market Access Regulation – African-Caribbean and Pacific states
Botswana (BW), Ivory Coast (CI), Ghana (GH), Cameroon (CM), Kenya (KE), Namibia (NM),
Swaziland (SZ).
Central America: Costa Rica (CR, El Salvador (SV), Guatemala (GT) Honduras (HN, Nicaragua (NI), Panama (PA).
West-Pacific: Fiji (FJ), Papua New Guinea (PG).
* For an actual overview of this countries please contact the Chamber of Commerce
(6) To be completed, where necessary, only for goods having preferential origin status in the context of preferential traderelations with one of the countries with which pan-Euro-Mediterranean cumulation of origin is applicable:
Algeria (DZ), Egypt (EG), European Union (EU), Faroe Islands (FO), Iceland (IS), Israel (IL) Jordan (JO),
Lebanon (LB), Liechtenstein (LI), Morocco (MA), Norway (NO), Tunisia (TN), Turkey (TR), West bank and
Gaza Strip (PS), Switzerland (CH).
Point of attention: As Syria did not yet sign the Pan Euro Med agreement it is not possible to fill in this country.
(7) Give the dates. The period shall not exceed 24 months or 12 months if the declaration was issued retrospectively.
[1] Declaration according to Regulation (EU) 2015/2447 art. 62, Annex 22-16 (PB L 343 of 29.12.2015)