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        | 영문 원산지증명서 |  
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        | GSTP 원산지증명서 
 1. Goods consigned from(Exporter's business name, address, country)
 
 Reference No.
 
 PREFERENTIAL ARRANGEMENTS
 AMONG DEVELOPING COUNTRIES
 NEGOTIATED IN GATT
 
 CERTIFICATE OF ORIGIN
 (Combined declaration and certificate)
 
 Issued in .....................................................................
 (country)
 See Notes overleaf
 2. Goods consigned to (Consignee's name, address, country)
 
 4. For Official use
 3. Means of transport and route (as far as known)
 
 5. Item
 No.
 6. Marks and
 numbers of
 packages
 7. No. & kind of packages; description of goods
 8. Origin
 criterion
 (see Instructions overleaf)
 9. Gross
 weight or
 other quantity
 10. Number and date of invoices
 
 11. Certification
 It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct.
 
 ........................................................................................................
 Place and date signature and stamp of certifying authority
 12. Declaration by the exporter
 The undersigned hereby declares that the above details and statements are correct; that all the goods were
 
 produced in ..........................................................
 (country)
 and that they comply with the origin requirements specified for those goods in the Preferential Arrangements AmongDeveloping Countries for goods exported to
 
 ...............................................................................
 (importing country)
 ...............................................................................
 Place and date, signature authorized signatory
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