| 1.Goods consigned from(exporter s business name, address, country)
 
 Reference No
 
 GENERALIZED SYSTEM OF PREFERENCES
 CERTIFICATE OF ORIGIN
 (Combined declaration and Certificate)
 FORM A
 
 Issued in
 (Country)
 See Notes Overleaf
 2.Goods consigned to (consignee s name, address, country)
 
 3.Means of transport and route(as far as known)
 FROM :
 TO :
 BY :
 
 4.For official use
 
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