Zako n o potvrđivanju regionalne konvencije o pan-evro –mediteranskim preferencijalnim pravilima o poreklu član 1

ANNEX III a

SPECIMENS OF MOVEMENT CERTIFICATE EUR.1

AND APPLICATION FOR A MOVEMENT CERTIFICATE EUR.1

Printing instructions

1. Each form shall measure 210 x 297 mm; a tolerance of up to minus 5 mm or plus 8 mm in the length may be allowed. The paper used must be white, sized for writing, not containing mechanical pulp and weighing not less than 25 g/m². It shall have a printed green guilloche pattern background making any falsification by mechanical or chemical means apparent to the eye.

2. The competent authorities of the Contracting Parties may reserve the right to print the forms themselves or may have them printed by approved printers. In the latter case, each form shall include a reference to such approval. Each form shall bear the name and address of the printer or a mark by which the printer can be identified. It shall also bear a serial number, either printed or not, by which it can be identified.

DECLARATION BY THE EXPORTER

I, the undersigned, exporter of the goods described overleaf,

DECLARE that the goods meet the conditions required for the issue of the attached certificate;

SPECIFY as follows the circumstances which have enabled these goods to meet the above conditions:

……………………………………………………………………………………………...

……………………………………………………………………………………………...

……………………………………………………………………………………………...

……………………………………………………………………………………………...

SUBMIT the following supporting documents (¹):

……………………………………………………………………………………………...

……………………………………………………………………………………………...

……………………………………………………………………………………………...

……………………………………………………………………………………………...

UNDERTAKE to submit, at the request of the appropriate authorities, any supporting evidence which these authorities may require for the purpose of issuing the attached certificate, and undertake, if required, to agree to any inspection of my accounts and to any check on the processes of manufacture of the above goods, carried out by the said authorities;

REQUEST the issue of the attached certificate for these goods.

(Place and date)

…………

(Signature)

…………

⁽¹⁾ For example: import documents, movement certificates, invoices, manufacturer's declarations, etc., referring to the products used in manufacture or to the goods re-exported in the same state.

ANNEX III b

SPECIMENS OF MOVEMENT CERTIFICATE EUR-MED

AND APPLICATION FOR A MOVEMENT CERTIFICATE EUR-MED

Printing instructions

1. Each form shall measure 210 x 297 mm; a tolerance of up to minus 5 mm or plus 8 mm in the length may be allowed. The paper used shall be white, sized for writing, not containing mechanical pulp and weighing not less than 25 g/m². It shall have a printed green guilloche pattern background making any falsification by mechanical or chemical means apparent to the eye.

2. The competent authorities of the Contracting Parties may reserve the right to print the forms themselves or may have them printed by approved printers. In the latter case, each form shall include a reference to such approval. Each form shall bear the name and address of the printer or a mark by which the printer can be identified. It shall also bear a serial number, either printed or not, by which it can be identified.

DECLARATION BY THE EXPORTER

I, the undersigned, exporter of the goods described overleaf,

DECLARE that the goods meet the conditions required for the issue of the attached certificate;

SPECIFY as follows the circumstances which have enabled these goods to meet the above conditions:

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

SUBMIT the following supporting documents (¹):

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

UNDERTAKE to submit, at the request of the appropriate authorities, any supporting evidence which these authorities may require for the purpose of issuing the attached certificate, and undertake, if required, to agree to any inspection of my accounts and to any check on the processes of manufacture of the above goods, carried out by the said authorities;

REQUEST the issue of the attached certificate for these goods.

(Place and date)

…………….

(Signature)

……………..

⁽¹⁾ For example: import documents, movement certificates, invoices, manufacturer's declarations, etc., referring to the products used in manufacture or to the goods re-exported in the same state.

ANNEX IVa

Text of the ORIGIN declaration

The origin declaration, the text of which is given below, must be made out in accordance with the footnotes. However, the footnotes do not have to be reproduced.

Albanian version

Eksportuesi i produkteve të mbuluara nga ky dokument (autorizim doganor Nr. ..............⁽¹⁾) deklaron që përveç rasteve kur tregohet qartësisht ndryshe, këto produkte janë me origjine preferenciale ..............⁽²⁾.

Bosnian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlaštenje br ………⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi …………⁽²⁾ preferencijalnog porijekla.

Bulgarian version

Iznositelяt na produktite, obhvanati ot tozi dokument (mitničesko razrešenie № …⁽¹⁾) deklarira, če osven kъdeto яsno e otbelяzano drugo, tezi produkti sa s … preferencialen proizhod ⁽²⁾.

Spanish version

El exportador de los productos incluidos en el presente documento (autorización aduanera n° …⁽¹⁾) declara que, salvo indicación en sentido contrario, estos productos gozan de un origen preferencial …⁽²⁾.

Croatian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlaštenje br. ..........⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog podrijetla.

Czech version

Vývozce výrobků uvedených v tomto dokumentu (číslo povolení …⁽¹⁾) prohlašuje, že kromě zřetelně označených mají tyto výrobky preferenční původ v …⁽²⁾.

Danish version

Eksportøren af varer, der er omfattet af nærværende dokument, (toldmyndighedernes tilladelse nr. ...⁽¹⁾), erklærer, at varerne, medmindre andet tydeligt er angivet, har præferenceoprindelse i ...⁽²⁾.

German version

Der Ausführer (Ermächtigter Ausführer; Bewilligungs-Nr. ...⁽¹⁾) der Waren, auf die sich dieses Handelspapier bezieht, erklärt, dass diese Waren, soweit nicht anderes angegeben, präferenzbegünstigte ...⁽²⁾ Ursprungswaren sind.

Estonian version

Käesoleva dokumendiga hõlmatud toodete eksportija (tolliameti kinnitus nr. ...⁽¹⁾) deklareerib, et need tooted on ...⁽²⁾ sooduspäritoluga, välja arvatud juhul kui on selgelt näidatud teisiti.

Greek version

Ο εξαγωγέας των προϊόντων που καλύπτονται από το παρόν έγγραφο (άδεια τελωνείου υπ΄αριθ. ...⁽¹⁾) δηλώνει ότι, εκτός εάν δηλώνεται σαφώς άλλως, τα προϊόντα αυτά είναι προτιμησιακής καταγωγής ...⁽²⁾.

English version

The exporter of the products covered by this document (customs authorization No ...⁽¹⁾) declares that, except where otherwise clearly indicated, these products are of ...⁽²⁾ preferential origin.

French version

L'exportateur des produits couverts par le présent document (autorisation douanière n° ...⁽¹⁾) déclare que, sauf indication claire du contraire, ces produits ont l'origine préférentielle ...⁽²⁾.

Italian version

L'esportatore delle merci contemplate nel presente documento (autorizzazione doganale n. ...⁽¹⁾) dichiara che, salvo indicazione contraria, le merci sono di origine preferenziale ...⁽²⁾.

Latvian version

Eksportētājs produktiem, kuri ietverti šajā dokumentā (muitas pilnvara Nr. …⁽¹⁾), deklarē, ka, izņemot tur, kur ir citādi skaidri noteikts, šiem produktiem ir priekšrocību izcelsme no …⁽²⁾.

Lithuanian version

Šiame dokumente išvardintų prekių eksportuotojas (muitinės liudijimo Nr. …⁽¹⁾) deklaruoja, kad, jeigu kitaip nenurodyta, tai yra …⁽²⁾ preferencinės kilmės prekės.

Hungarian version

A jelen okmányban szereplő áruk exportőre (vámfelhatalmazási szám: …⁽¹⁾) kijelentem, hogy eltérő egyértelmű jelzés hiányában az áruk kedvezményes …⁽²⁾ származásúak.

Version of the former Yugoslav Republic of Macedonia

Izvoznikot na proizvodite što gi pokriva ovoj dokument (carinsko odobrenie br. ……⁽¹⁾) izjavuva deka, osven ako toa ne e jasno poinaku naznačeno, ovie proizvodi se so .........………….⁽²⁾ preferencijalno poteklo.

Maltese version

L-esportatur tal-prodotti koperti b'dan id-dokument (awtorizzazzjoni tad-dwana nru. …⁽¹⁾) jiddikjara li, ħlief fejn indikat b'mod ċar li mhux hekk, dawn il-prodotti huma ta' oriġini preferenzjali …⁽²⁾.

Montenegrin version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br. ......⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog porijekla.

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br ................⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..................................⁽²⁾ preferencijalnog porijekla.

Dutch version

De exporteur van de goederen waarop dit document van toepassing is (douanevergunning nr. ...⁽¹⁾), verklaart dat, behoudens uitdrukkelijke andersluidende vermelding, deze goederen van preferentiële ... oorsprong zijn ⁽²⁾.

Polish version

Eksporter produktów objętych tym dokumentem (upoważnienie władz celnych nr …⁽¹⁾) deklaruje, że z wyjątkiem gdzie jest to wyraźnie określone, produkty te mają …⁽²⁾ preferencyjne pochodzenie.

Portuguese version

O abaixo assinado, exportador dos produtos cobertos pelo presente documento (autorização aduaneira n° ⁽¹⁾), declara que, salvo expressamente indicado em contrário, estes produtos são de origem preferencial ...⁽²⁾.

Romanian version

Exportatorul produselor ce fac obiectul acestui document (autorizaţia vamală nr. …⁽¹⁾) declară că, exceptând cazul în care în mod expres este indicat altfel, aceste produse sunt de origine preferenţială …⁽²⁾.

Serbian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br. ......⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog porekla.

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br ................⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..................................⁽²⁾ preferencijalnog porekla.

Slovenian version

Izvoznik blaga, zajetega s tem dokumentom (pooblastilo carinskih organov št …⁽¹⁾) izjavlja, da, razen če ni drugače jasno navedeno, ima to blago preferencialno …⁽²⁾ poreklo.

Slovak version

Vývozca výrobkov uvedených v tomto dokumente (číslo povolenia …⁽¹⁾) vyhlasuje, že okrem zreteľne označených, majú tieto výrobky preferenčný pôvod v …⁽²⁾.

Finnish version

Tässä asiakirjassa mainittujen tuotteiden viejä (tullin lupa n:o ...⁽¹⁾) ilmoittaa, että nämä tuotteet ovat, ellei toisin ole selvästi merkitty, etuuskohteluun oikeutettuja ... alkuperätuotteita ⁽²⁾.

Swedish version

Exportören av de varor som omfattas av detta dokument (tullmyndighetens tillstånd nr. ...⁽¹⁾) försäkrar att dessa varor, om inte annat tydligt markerats, har förmånsberättigande ... ursprung ⁽²⁾.

Arabic version

Hebrew version

Faeroese version

Ùtflytarin av vørunum, sum hetta skjal fevnir um (tollvaldsins loyvi nr. ...⁽¹⁾) váttar, at um ikki nakað annað er tilskilað, eru hesar vørur upprunavørur ...⁽²⁾.

Icelandic version

Útflytjandi framleiðsluvara sem skjal þetta tekur til (leyfi tollyfirvalda nr …⁽¹⁾), lýsir því yfir að vörurnar séu, ef annars er ekki greinilega getið, af … fríðindauppruna ⁽²⁾.

Norwegian version

Eksportøren av produktene omfattet av dette dokument (tollmyndighetenes autorisasjons nr …⁽¹⁾) erklærer at disse produktene, unntatt hvor annet er tydelig angitt, har … preferanseopprinnelse ⁽²⁾.

Turkish version

İşbu belge (gümrük onay No: …⁽¹⁾) kapsamındaki maddelerin ihracatçısı aksi açıkça belirtilmedikçe, bu maddelerin … tercihli menşeli ⁽²⁾ maddeler olduğunu beyan eder.

……………………………………………………………...........................................⁽³⁾

^{(Place and date)}

...……………………………………………………………………...........................⁽⁴⁾

<sup>(Signature of the exporter, in addition the name of the person signing the declaration has to be indicated in clear script)

(1) When the origin declaration is made out by an approved exporter, the authorisation number of the approved exporter must be entered in this space. When the origin declaration is not made out by an approved exporter, the words in brackets shall be omitted or the space left blank.

(2) Origin of products to be indicated. When the origin declaration relates in whole or in part, to products originating in Ceuta and Melilla, the exporter must clearly indicate them in the document on which the declaration is made out, by means of the symbol "CM".

(3) These indications may be omitted if the information is contained on the document itself.

(4) In cases where the exporter is not required to sign, the exemption of signature also implies the exemption of the name of the signatory.</sup>

ANNEX IVb

Text of the ORIGIN declaration EUR-MED

The origin declaration EUR-MED, the text of which is given below, must be made out in accordance with the footnotes. However, the footnotes do not have to be reproduced.

Albanian version

Eksportuesi i produkteve të mbuluara nga ky dokument (autorizim doganor Nr. ..............⁽¹⁾) deklaron që përveç rasteve kur tregohet qartësisht ndryshe, këto produkte janë me origjine preferenciale..............⁽²⁾.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Bosnian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlaštenje br ………⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi …………⁽²⁾ preferencijalnog porijekla.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Bulgarian version

Iznositelяt na produktite, obhvanati ot tozi dokument (mitničesko razrešenie № …⁽¹⁾) deklarira, če osven kъdeto яsno e otbelяzano drugo, tezi produkti sa s … preferencialen proizhod ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Spanish version

El exportador de los productos incluidos en el presente documento (autorización aduanera n° …⁽¹⁾.) declara que, salvo indicación en sentido contrario, estos productos gozan de un origen preferencial …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Croatian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlaštenje br. ..........⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog podrijetla.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Czech version

Vývozce výrobků uvedených v tomto dokumentu (číslo povolení …⁽¹⁾) prohlašuje, že kromě zřetelně označených mají tyto výrobky preferenční původ v …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Danish version

Eksportøren af varer, der er omfattet af nærværende dokument, (toldmyndighedernes tilladelse nr. ...⁽¹⁾), erklærer, at varerne, medmindre andet tydeligt er angivet, har præferenceoprindelse i ...⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

German version

Der Ausführer (Ermächtigter Ausführer; Bewilligungs-Nr. ...⁽¹⁾) der Waren, auf die sich dieses Handelspapier bezieht, erklärt, dass diese Waren, soweit nicht anderes angegeben, präferenzbegünstigte ...⁽²⁾ Ursprungswaren sind.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Estonian version

Käesoleva dokumendiga hõlmatud toodete eksportija (tolliameti kinnitus nr. ...⁽¹⁾) deklareerib, et need tooted on ...⁽²⁾ sooduspäritoluga, välja arvatud juhul kui on selgelt näidatud teisiti.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Greek version

Ο εξαγωγέας των προϊόντων που καλύπτονται από το παρόν έγγραφο (άδεια τελωνείου υπ΄αριθ. ...⁽¹⁾) δηλώνει ότι, εκτός εάν δηλώνεται σαφώς άλλως, τα προϊόντα αυτά είναι προτιμησιακής καταγωγής ...⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

English version

The exporter of the products covered by this document (customs authorization No ...⁽¹⁾) declares that, except where otherwise clearly indicated, these products are of ...⁽²⁾ preferential origin.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

French version

L'exportateur des produits couverts par le présent document (autorisation douanière n° ...⁽¹⁾) déclare que, sauf indication claire du contraire, ces produits ont l'origine préférentielle ...⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Italian version

L'esportatore delle merci contemplate nel presente documento (autorizzazione doganale n. ...⁽¹⁾) dichiara che, salvo indicazione contraria, le merci sono di origine preferenziale ....⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Latvian version

Eksportētājs produktiem, kuri ietverti šajā dokumentā (muitas pilnvara Nr. …⁽¹⁾), deklarē, ka, izņemot tur, kur ir citādi skaidri noteikts, šiem produktiem ir priekšrocību izcelsme no …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Lithuanian version

Šiame dokumente išvardintų prekių eksportuotojas (muitinės liudijimo Nr. …⁽¹⁾) deklaruoja, kad, jeigu kitaip nenurodyta, tai yra …⁽²⁾ preferencinės kilmės prekės.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Hungarian version

A jelen okmányban szereplő áruk exportőre (vámfelhatalmazási szám: …⁽¹⁾) kijelentem, hogy eltérő egyértelmű jelzés hiányában az áruk kedvezményes …⁽²⁾ származásúak.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Version of the former Yugoslav Republic of Macedonia

Izvoznikot na proizvodite što gi pokriva ovoj dokument (carinsko odobrenie br. ……⁽¹⁾) izjavuva deka, osven ako toa ne e jasno poinaku naznačeno, ovie proizvodi se so .........………….⁽²⁾ preferencijalno poteklo.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Maltese version

L-esportatur tal-prodotti koperti b'dan id-dokument (awtorizzazzjoni tad-dwana nru. …⁽¹⁾) jiddikjara li, ħlief fejn indikat b'mod ċar li mhux hekk, dawn il-prodotti huma ta' oriġini preferenzjali …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Montenegrin version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br. ......⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog porijekla.

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br ................⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..................................⁽²⁾ preferencijalnog porijekla.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Dutch version

De exporteur van de goederen waarop dit document van toepassing is (douanevergunning nr. ...⁽¹⁾), verklaart dat, behoudens uitdrukkelijke andersluidende vermelding, deze goederen van preferentiële ... oorsprong zijn ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)
- no cumulation applied ⁽³⁾

Polish version

Eksporter produktów objętych tym dokumentem (upoważnienie władz celnych nr …⁽¹⁾) deklaruje, że z wyjątkiem gdzie jest to wyraźnie określone, produkty te mają …⁽²⁾ preferencyjne pochodzenie.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Portuguese version

O abaixo assinado, exportador dos produtos cobertos pelo presente documento (autorização aduaneira n°. ...⁽¹⁾), declara que, salvo expressamente indicado em contrário, estes produtos são de origem preferencial ...⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Romanian version

Exportatorul produselor ce fac obiectul acestui document (autorizaţia vamală nr. …⁽¹⁾) declară că, exceptând cazul în care în mod expres este indicat altfel, aceste produse sunt de origine preferenţială …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Serbian version

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br. ......⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..........⁽²⁾ preferencijalnog porekla.

Izvoznik proizvoda obuhvaćenih ovom ispravom (carinsko ovlašćenje br ................⁽¹⁾) izjavljuje da su, osim ako je to drugačije izričito navedeno, ovi proizvodi ..................................⁽²⁾ preferencijalnog porekla.

- cumulation applied with .... (name of the country/countries)

- no cumulation applied ⁽³⁾

Slovenian version

Izvoznik blaga, zajetega s tem dokumentom (pooblastilo carinskih organov št …⁽¹⁾) izjavlja, da, razen če ni drugače jasno navedeno, ima to blago preferencialno …⁽²⁾ poreklo.

- cumulation applied with ……..(name of the country/countries)
- no cumulation applied ⁽³⁾

Slovak version

Vývozca výrobkov uvedených v tomto dokumente (číslo povolenia …⁽¹⁾) vyhlasuje, že okrem zreteľne označených, majú tieto výrobky preferenčný pôvod v …⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Finnish version

Tässä asiakirjassa mainittujen tuotteiden viejä (tullin lupa n:o ...⁽¹⁾) ilmoittaa, että nämä tuotteet ovat, ellei toisin ole selvästi merkitty, etuuskohteluun oikeutettuja ... alkuperätuotteita ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Swedish version

Exportören av de varor som omfattas av detta dokument (tullmyndighetens tillstånd nr. ...⁽¹⁾) försäkrar att dessa varor, om inte annat tydligt markerats, har förmånsberättigande ... ursprung ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Arabic version

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Hebrew version

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Faeroese version

Ùtflytarin av vørunum, sum hetta skjal fevnir um (tollvaldsins loyvi nr. ...⁽¹⁾) váttar, at um ikki nakað annað er tilskilað, eru hesar vørur upprunavørur ...⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Icelandic version

Útflytjandi framleiðsluvara sem skjal þetta tekur til (leyfi tollyfirvalda nr …⁽¹⁾), lýsir því yfir að vörurnar séu, ef annars er ekki greinilega getið, af … fríðindauppruna ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Norwegian version

Eksportøren av produktene omfattet av dette dokument (tollmyndighetenes autorisasjons nr …⁽¹⁾) erklærer at disse produktene, unntatt hvor annet er tydelig angitt, har … preferanseopprinnelse ⁽²⁾.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

Turkish version

İşbu belge (gümrük onay No: …⁽¹⁾) kapsamındaki maddelerin ihracatçısı aksi açıkça belirtilmedikçe, bu maddelerin … tercihli menşeli ⁽²⁾ maddeler olduğunu beyan eder.

- cumulation applied with ……..(name of the country/countries)

- no cumulation applied ⁽³⁾

…………………………………………………………….............................................⁽⁴⁾

^{(Place and date)}

...……………………………………………………………………..............................⁽⁵⁾

Signature of the exporter, in addition the name of the person signing the declaration has to be indicated in clear script)

<sup>(1) When the origin declaration is made out by an approved exporter, the authorisation number of the approved exporter must be entered in this space. When the origin declaration is not made out by an approved exporter, the words in brackets shall be omitted or the space left blank.

(2) Origin of products to be indicated. When the origin declaration relates, in whole or in part, to products originating in Ceuta and Melilla, the exporter must clearly indicate them in the document on which the declaration is made out, by means of the symbol "CM".

(3) Complete and delete where necessary.

(4) These indications may be omitted if the information is contained on the document itself.

(5) In cases where the exporter is not required to sign, the exemption of signature also implies the exemption of the name of the signatory.</sup>