SPORTER (Fuil Name & Address)
CONSIGNCE (if required)
Carrier
Port of Discharge
Mark(s) & Number(s)
Certificate No.
CERTIFICATE OF
HONG KONG ORIGIN
Port of Loading
Date of Departure
Country of Destination
Final Destination. If on Carriage
Factory Number
(on or about)
Number and Type of Packages & Description of Goods
Quantity or Weight (in words and figures)
Brand Names er Labels (if any)
SPECIMEN
I hereby certify that the goods described above were made in Hong Kong, I further certify that the goods described above meet the origin rules of the European Economic Community.*
W
*The certification may be atamped on the certificate.