Australia-India ECTA Annex 4A (Minimum Information Requirements)

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Exporter’s Name, Address, and Country:
- Certification No.
- Number of pages
Producer’s Name, Address, and Country:
INDIA-AUSTRALIA ECONOMIC COOPERATION AND TRADE AGREEMENT

CERTIFICATE OF ORIGIN
Importer or Consignee’s Name, Address, and Country:
Transport details:
Item number (as necessary); Marks and numbers; Number and kind of packages; Description of good(s); HS Code (six-digit level)
ORIGIN criterion (see overleaf note)
☐ Cumulation (if applicable)
Gross Weight or other Quantity
Invoice number(s) and date(s)
Remarks: (if applicable)
☐ ISSUED RETROSPECTIVELY
Non-Party Invoicing Name, Address, and Country (if applicable)
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:
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: