CERTIFICAT DE ORIGINE CERTIFICATE OF ORIGIN ... - ccibv.ro · numarul sau "in vrac") litem number:...
2
vA RUGAM CITITI REGULILE §I NOTELE DE PE VERSO INAINTE DE A COMPLETA ACEST FORMULAR I PLEASE READ THE RULES AND NOTES OVERLEAF BEFORE COMPLETING THIS FORM I PRIEZ LIRE LES REGLES ET LES NOTES AUVERSO AVANTDE COMPLETER LE FORMULAIRE 1 Expeditor (nume sau denumirea finnel, adresa compleUi, conform datelor inscrise in reglstrul comertului) IConsignor (name or name of firm, full address, as in the commercial register) I Expedfteur (nom au raison sociale, adresse complete tels qu'ils figurent Ie cas BcMant au ragistre du commerce). No. CERERE . APPLICATION. DEMANDE DE DELlVRANCE COMUNITATEA EUROPEANA EUROPEAN COMMUNITY COMMUNAUTE EUROPEENNE CERTIFICAT DE ORIGINE CERTIFICATE OF ORIGIN CERTIFICAT D'ORIGINE 2 Destinatar (nume sau denumlrea finnel, adresa compleUi, daca se cuno8!jte, sau men11unea "Ia ontln") I Consignee(name or name of firm, full adress, if known, or mention "to order") I Destinataire(nom au raison sociale, adresse complete tels que connus, au mention "8 ordre") 3 Tara de orlglne (Comunltatea Europeana sau jars de origlne Interesata) I Country of origin (European Community or country of origin concerned) I Pays d'origine (Communaute europeenne au pays d'origine concern"') 4 Detalil transport (optional) I Transport details (optional) I Informations relatives au transport (mention facultative) 5 Observatli I Remarks I Remarques 6 Numarul artlcolulul: marcl, numere, numarul ,i natura coletelor; descrierea marfurilor (pentru marfurl neambalate se Indica numarul sau "in vrac") litem number: marks, numbers, number and kind of packages; description of goods (for goods not packed indicate number or "in bulk") I Numero d'ordre: marques, numeros, nombre et nature des colis; designation des marchandises (pour les marchandises non emballees nombre d'objets au mention "en vrac") 7 Cantltatea (exprimata ca greutate bruta sau neta sau alte unltatl de masura) I Quantity (expressed in gross or net weight or other units of measure) I Quantite (exprimee en masse brute au masse nette au en d'autres unites de mesure) " 8 Subsemnatul,I', the undersigned, I Je soussigoo - SOLICITeliberareaunuicertificatdeoriginecare sa atesteca marfuriledescrisemaisus provindin tara indicatiiin casela 31APPLYfortheissueof a certificateof originindicatingthat thegoodsdescribed aboveoriginatein the countryshownin box 3. I DEMANDE la delivrance d'un certificat d'origine indiquant que les marchandises designees ci-dessus sont originaires du pays figurant dans la case no. 3. - DECLARca elementeleinscrisein aceastacerere~idocumenteledoveditoare~iinforma~ilefumizateautoritatiilorcompetentein vedereaeliberariiprezentuluieertificatsuntcorecte, ca marfurilelacarese retemacestedocumente~iinforma~isunteelepentrucareseprezintaaeeastaeerere,ca marfurilerespectacondi~ileprevazutedereglementarileprivitoare la definitiacomunc!l aconceptuluide originea marfurilor I DECLARE that the particulars given in this applicationand the supporting documents and informationfurnished to the competent authorities with a view to the issue of this certificate are coffect, that the goods to which such documents and informationrelate are those in respect of which this application is made, that the goods fulfilthe conditions laid down by the rules concerning the common definitionof the concept of the originat goods. I DECLARE que les indications de cette demande ainsi que les pieces justificatives presentees et les renseignements fournisaux autoritesau organismeshabilitesen vue de ladelivrancede ce certificat sont exacts, que les marchandises auxquelles se rapportent ces pieces et renseignements sont celles pour lesquelles Ie certificat est demande, que ces marchandisesremplissentles conditionsprevues parlareglementationrelative8 ladefinitioncommune et de la notiond'origine des marchandises. - MAANGAJEZsafumizez,lacerereaautoritatilorcompetente.taateinformatiilesuplimentare~idocumenteledoveditoareeesepotsolicitapentrueliberareacertificatului /1UNDERTAKEtofurnish,at the request of the competent authorities, such additionalinformationand supporting documents as may be required for the issue of the certificate.I M'ENGAGE a presenter. 8 la demande des autorites au organismes habilites, les renseignements et pieces justificatives supplementaires que ceux-ci jugeraient necessaires en vue de la delivrance du certificat. 9 Solicitant I Applicant / Demandeur (in cazul in care nu este aeeea,i persoana cu expeditonul)I (if not the consignor) I (s'll est autre que I'expediteur) Locul §I data I Place and date I Lieu et date Semnatura sollcltantulul I Signature of the applicant / Signature du demandeur Semnatura unui agent trebuie unmatade numele sau seris eu majuscule I The signature of an agent must be followed by his name in block capitals I La signature d'un fonde de pouvoir doit etre suivie de son nom en caracteres d'imprimerie.
Transcript of CERTIFICAT DE ORIGINE CERTIFICATE OF ORIGIN ... - ccibv.ro · numarul sau "in vrac") litem number:...
vA RUGAM CITITI REGULILE §I NOTELE DE PE VERSO INAINTE DE A COMPLETA ACEST FORMULAR I PLEASE READ THE RULES AND NOTESOVERLEAF BEFORE COMPLETING THIS FORM I PRIEZ LIRE LES REGLES ET LES NOTES AUVERSO AVANTDE COMPLETER LE FORMULAIRE
1 Expeditor (nume sau denumirea finnel, adresa compleUi, conform datelor inscrise
in reglstrul comertului) IConsignor (name or name of firm, full address, as in the commercial register) IExpedfteur (nom au raison sociale, adresse complete tels qu'ils figurent Ie cas BcMant au ragistredu commerce).
No. CERERE . APPLICATION.DEMANDE
DE DELlVRANCE
COMUNITATEA EUROPEANAEUROPEAN COMMUNITY
COMMUNAUTE EUROPEENNE
CERTIFICAT DE ORIGINECERTIFICATE OF ORIGINCERTIFICAT D'ORIGINE
2 Destinatar (nume sau denumlrea finnel, adresa compleUi, daca se cuno8!jte, sau men11unea"Ia ontln") I Consignee(name or name of firm, full adress, if known, or mention "to order") IDestinataire(nom au raison sociale, adresse complete tels que connus, au mention"8 ordre")
3 Tara de orlglne (Comunltatea Europeana sau jars de origlne Interesata) ICountry of origin (European Community or country of origin concerned) IPays d'origine (Communaute europeenne au pays d'origine concern"')
4 Detalil transport (optional) I Transportdetails (optional) I Informations relativesau transport (mention facultative)
5 Observatli I Remarks I Remarques
6 Numarul artlcolulul: marcl, numere, numarul ,i natura coletelor; descrierea marfurilor (pentru marfurl neambalate se Indicanumarul sau "in vrac") litem number: marks, numbers, number and kind of packages; description of goods (for goods not packedindicate number or "in bulk") I Numero d'ordre: marques, numeros, nombre et nature des colis; designation des marchandises(pour les marchandises non emballees nombre d'objets au mention "en vrac")
7 Cantltatea (exprimata ca greutate brutasau neta sau alte unltatl de masura) IQuantity (expressed in gross or net weight orother units of measure) I Quantite (exprimeeen masse brute au masse nette au end'autres unites de mesure)
"
8 Subsemnatul,I', the undersigned, I Je soussigoo
- SOLICITeliberareaunuicertificatdeoriginecaresa atesteca marfuriledescrisemaisusprovindin tara indicatii in casela 31APPLYfor the issueof a certificateof originindicatingthat thegoodsdescribedaboveoriginatein thecountryshownin box 3. I DEMANDE la delivrance d'un certificat d'origine indiquant que les marchandises designees ci-dessus sont originaires du pays figurant dansla case no. 3.
- DECLARca elementeleinscrisein aceastacerere~i documenteledoveditoare~iinforma~ilefumizateautoritatiilorcompetentein vedereaeliberariiprezentuluieertificatsuntcorecte,ca marfurilela carese retemacestedocumente~i informa~isunteelepentrucarese prezintaaeeastaeerere,ca marfurilerespectacondi~ileprevazutede reglementarileprivitoarela definitiacomunc!la conceptuluide originea marfurilorI DECLARE that the particularsgiven in this applicationand the supporting documents and informationfurnished to the competent authorities witha view to the issue of this certificate are coffect, that the goods to which such documents and informationrelate are those in respect of which this application is made, that the goods fulfilthe conditions laiddown by the rules concerning the common definitionof the concept of the originat goods. I DECLARE que les indications de cette demande ainsi que les pieces justificatives presentees et lesrenseignements fournisaux autoritesau organismeshabilitesen vue de ladelivrancede ce certificatsont exacts, que les marchandises auxquelles se rapportent ces pieces etrenseignements sont celles pour lesquelles Ie certificat est demande, que ces marchandisesremplissentles conditionsprevues par lareglementationrelative8 ladefinitioncommuneet de la notiond'origine des marchandises.
- MAANGAJEZsa fumizez,la cerereaautoritatilorcompetente.taateinformatiilesuplimentare~i documenteledoveditoareeese potsolicitapentrueliberareacertificatului/1UNDERTAKEto furnish,at therequest of the competent authorities, such additionalinformationand supporting documents as may be required for the issue of the certificate.I M'ENGAGE a presenter. 8 la demande des autoritesau organismes habilites, les renseignements et pieces justificatives supplementaires que ceux-ci jugeraient necessaires en vue de la delivrance du certificat.
9 Solicitant I Applicant / Demandeur(in cazul in care nu este aeeea,i persoana cu expeditonul)I (if not the consignor) I(s'll est autre que I'expediteur) Locul §I data I Place and date I Lieu et date
Semnatura sollcltantulul I Signature of the applicant / Signature du demandeurSemnatura unui agent trebuie unmatade numele sau seris eu majuscule IThe signature of an agent must be followed by his name in block capitals ILa signature d'un fonde de pouvoir doitetre suivie de son nom en caracteres d'imprimerie.
