Supplier's declaration for productshavingpreferential origin status[1]

The supplier’s declaration, the text of which is given below, must be made out in accordance with the footnotes.

DECLARATION

I, the undersigned, declare that the goods listed on this document ……………………………(1)

originate in ……………………………(2) and satisfy the rules of origin governing preferential

trade with (3):

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(4):

�Cumulation applied with ……..……….(name of the country/countries)

�No cumulation applied

I undertake to make available to the customs authorities any further supporting documents they require:

Place and date : ……………………………………….
Name and position
in the company : ………………….……………………
Signature : ………………….……………………

the supplier shall include the declaration on the commercial invoice relating to that consignment, on a delivery note or on any other commercial document which describes the goods concerned in sufficient detail to enable them to be identified.
The supplier may provide the declaration at any time, even after the goods have been delivered.

(1)Number and date of the commercial invoice, the delivery note or any other commercial document.
If only some of the goods listed on the document are concerned, they shall be clearly indicated or marked and this marking entered in the declaration as follows:
“……….. listed on this document and marked ……………. Originate in …………..”

(2)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– includesthe EU countries, Algeria (DZ) , Egypt (EG), Faroe Islands (FO), Iceland (IS), Israel (IL), Jordan (JO), Lebanon (LB), Liechtenstein (LI), Morocco (MA), Norway (NO),West bank and Gaza Strip (PS), Switzerland (CH), Syria (SY), Tunisia (TN) and Turkey (TR)or:

-SAPcumulation zone (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.

(3)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

(4)To be completed, where necessary, only for goods having preferential origin status in the context of preferential trade relations 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), Westbank 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 thiscountry.

[1]Declaration according to Regulation (EU) Nr. 2015/2447 art. 61, annex 22-15 (PB L 343 of 29.12.2015)