# Enclosure 2. or C. 656
R.
FONGKONG.
Form of declaration by the Exporter or his Agent.
CERTIFICATE OF ORIGIN FOR SUGAR MANUFACTURED IN HONGKONG
I, the undersigned Fiscal Authority do hereby certify:
That Mr. [Name], the Firm of Messrs. [Firm Name], Partner, Secretary or (a) Director, authorised Manager, Agent, of Hongkong has declared before me, on his responsibility, that the Sugar designated below is the manufacture of the aforesaid Firm and is to be exported to (b) [Country of Destination].
Description | Number and Description of Packages | Marks and Numbers | Net Weight of Sugar, whether in cwts. | Polarization | Name of exporting vessel | No. | Description | Beet or Cane
So declared under my responsibility
[Signature of] Partner, Director, Manager, Secretary, or authorised Agent, of the Firm of Messrs. [Firm Name] this [day] day of [month], [year].
Fiscal Authority of Hongkong.
190[Year]
The validity of this Certificate expires twelve months from the date of the Declaration.
This Certificate is not applicable to Sugar in transit.
(a) Delete words which do not apply.
(b) Country of Destination.
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