Annexure-E - Format of the Certificate of Origin under the India-UAE Trade Agreement - Customs Tariff (Determination of Origin of Goods under the Comprehensive Economic Partnership Agreement between India and the United Arab Emirates) Rules, 2022

Annexure-E [see sub-rule (1) of rule 15] Format of the Certificate of Origin under the India-UAE Trade Agreement 1. Exporter s Name, Address, and Country: Certification No. Number of page 2. Manufacturer s Name, Address, and Country: AGREEMENT BETWEEN INDIA AND UAE CERTIFICATE OF ORIGIN 3. Importer s or Consignee s Name, Address, and Country: 4. Transport details 5. Item number (as necessary); Marks and numbers; Number and kind of packages; Description of good(s); HS tariff classification number 6. ORIGIN criterion (see overleaf note) Cumulation 7. Gross Weight or other Quantity 8. Invoice number(s) and date(s) 9. Remarks: ISSUED RETROSPECTIVELY 10. Third-Party Invoicing Name, Address, and Country 11. Declaration by the exporter: I, the undersigned, declare that: - the above details and statement are true and accurate; - the good(s) described above meet the condition(s) required for the issuance of this certificate; and - the country of origin of the good(s) described above is:______ Place and Date: Signature: Name (printed): Company: 12. Certification It is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct. Export Document Number: Issuing Authority: [Stamp] Place and Date: Signature: Overleaf Notes: The following origin criteria code should be inserted in Box 5: (i) WO for Wholly Obtained; or (ii) PSR for Product Specific Rules. [F. No. 15020/4/2021-ICD(CBEC)] KOMILA PUNIA, Dy. Secy.