Le format de ce formulaire est d’environ 210 × 297 millimètres. L’original est établi sur papier rendant apparente toute falsification par moyens mécaniques ou chimiques.
Les formulaires sont imprimés et remplis en langue anglaise.
L’original et sa copie conforme sont remplis soit de manière dactylographiée, soit à la main. Dans ce dernier cas, ils doivent être remplis à l’encre et en caractères d’imprimerie.
Chaque certificat d’authenticité comporte dans la case supérieure droite un numéro de série. La copie conforme porte le même numéro que l’original.
NB: This certificate is issued in conformity with the national legislation.
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1. Exporter (Name and full address)
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CERTIFICATE OF AUTHENTICITY
BASMATI RICE
for export to the European Union
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2. Consignee (Name and full address)
| No | ORIGINAL
| issued by (Name and full address of issuing body)
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3. Country and place of cultivation
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4. FOB value in US dollars
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5. Number and date of invoice
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6. Marks and numbers — Number and kind of packages — Description of goods
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7. Gross weight (kg)
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8. Net weight (kg)
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9. DECLARATION BY EXPORTER
The undersigned declares that the information shown above is correct.
| Place and date: | Signature:
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10. CERTIFICATION BY THE ISSUING BODY
It is hereby certified that the rice described above is BASMATI RICE and that the information shown in this certificate is correct.
| Place and date: | Signature: | Stamp:
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11. CERTIFICATION BY COMPETENT CUSTOMS OFFICE OF COUNTRY OF EXPORT
Customs formalities for export to the European Union of the rice described above have been completed.
Type, number and date of export document: Name and country of customs office:
| | Signature: | Stamp:
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12. FOR COMPETENT AUTHORITIES IN THE UNION