ANNEXURE-A - SAMPLE CERTIFICATE OF ORIGIN - Rules of (Determination of Origin of Goods under the Asia-Pacific Trade Agreement, (formerly known as the Bangkok Agreement)) Rules, 2006

ANNEXURE-A SAMPLE CERTIFICATE OF ORIGIN Asia-Pacific Trade Agreement (Combined declaration and certificate) 1.Goods consigned from: (Exporter's business name, address, country) Reference No. Issued in ...........(Country) 2. Goods consigned to: (Consignee's name, address, country) 3.For Official use 4. Means of transport and route: 5. Tariff item number: 6.Marks and number of Packages: 7. Number and kind of packages/description of goods: 8. Origin criterion (see notes overleaf) 9. Gross weight or other quantity: 10. Number and date of invoices: 11. 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 these goods in the Asia-Pacific Trade Agreement for goods exported to .................................... (Importing Country) ............................................................... Place and date, signature of authorized Signatory 12. Certificate 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 Notes for completing Certificate of Origin I. General Conditions: To qualify for preference, products must: (a) fall within a description of products eligible for preference in the list of concessions of an Asia-Pacific Trade Agreement country of destination; (b) comply with Asia-Pacific Trade Agreement rules of origin. Each article in a consignment must qualify separately in its own right; and (c) comply with the consignment conditions specified by the Asia-Pacific Trade Agreement rules of origin. In general, products must be consigned directly within the meaning of Rule 6 hereof from the country of exportation to the country of destination. II.Entries to be made in the boxes Box 1 Goods Consigned from Type the name, address and country of the exporter. The name must be the same as the exporter described in the invoice. Box 2 Goods Consigned to Type the name, address and country of the importer. The name must be the same as the importer described in the invoice. For third party trade, the words To Order may be typed. Box 3 For Official Use Reserved for use by certifying authority. Box 4 Means of Transport and Route State in detail the means of transport and route for the products exported. If the L/C terms etc. do not require such details, type By Air or By Sea. If the products are transported through a third country this can be indicated as follows: e.g. By Air Laos to India via Bangkok Box 5 Tariff Item Number Type the 1 [ 6-digit HS heading ] of the individual items. Box 6 Marks and Numbers of Packages Type the marks and numbers of the packages covered by the Certificate. This information should be identical to the marks and numbers on the packages. Box 7 Number and Kind of Packages; Description of Goods Type clearly the description of the products exported. This should be identical to the description of the products contained in the invoice. An accurate description will help the Customs Authority of the country of destination to clear the products quickly. Box 8 Origin Criterion Preference products must be wholly produced or obtained in the exporting ParticipatingState in accordance with Rule 3 of the Asia-Pacific Trade Agreement Rules of Origin, or where not wholly produced or obtained in the exporting ParticipatingState must be eligible under Rule 4 or Rule 5. 2 [ (a) Products wholly produced or obtained: enter the letter A in Box 8. (b) Products not wholly produced or obtained: the entry in Box 8 should be as follows: 1. Enter letter B in Box 8, for products, which meet the origin criteria according to Rule 4. Entry of letter B would be followed by the sum of the value of materials, parts or produce originating from non-Participating States, or undetermined origin used, expressed as a percentage of the f.o.b. value of the products; (example B 50 per cent); 2. Enter letter C in Box 8 for products, which meet the origin criteria according to Rule 5. Entry of letter C would be followed by the sum of the aggregate content originating in the territory of the exporting Participating State expressed as a percentage of the f.o.b. value of the exported product; (example C 60 per cent); 3. Enter letter D in Box 8 for products, which meet the special origin criteria according to Rule 11; 4. Enter letter E in Box 8 for products which meet the origin criteria according to sub-rule (b) of rule 4. Entry of letter E would be followed by the criteria of the rules of origin (example E CTH). ] Box 9 Gross Weight or Other Quantity Type the gross weight or other quantity (such as pieces, kg) of the products covered by the Certificate. Box 10 Number and Date of Invoices State number and date of the invoice in question. The date of the invoice attached to the Application should not be later than the date of approval on the Certificate. Box 11 Declaration by the Exporter The term Exporter refers to the shipper who can either be a trader or a manufacturer. Type the name of the producing country and the importing country and the place and date when the declaration is made. This box must be signed by the Company's authorized signatory. Box 12 Certification The certifying authority will certify in this Box. ********* Notes 1. Substituted vide Notification No. 59/2018 - Customs (N.T.) dated 30-06-2018 before it was read as 4-digit HS heading 2. Substituted vide Notification No. 59/2018 - Customs (N.T.) dated 30-06-2018 before it was read as (a) Products wholly produced or obtained: enter the letter A in Box 8. Products not wholly produced or obtained: the entry in Box 8 should be as follows: 1. Enter letter B in Box 8, for products, which meet the origin criteria according to Rule 4. Entry of letter B would be followed by the sum of the value of materials, parts or produce originating from non-Participating States, or undetermined origin used, expressed as a percentage of the f.o.b. value of the products; (example B 50 per cent); 2. Enter letter C in Box 8 for products, which meet the origin criteria according to Rule 5. Entry of letter C would be followed by the sum of the aggregate content originating in the territory of the exporting Participating State expressed as a percentage of the f.o.b. value of the exported product; (example C 60 per cent); 3. Enter letter D in Box 8 for products, which meet the special origin criteria according to Rule 11.