Form No. CCI-1(1975. 10. 1) |
1. Goods consigned from(Exporter's name, address, country)
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CERTIFICATE OF ORIGIN (Combined declaration and certificate) issued by KOREA CHAMBER OF COMMERCE AND INDUSTRY Seoul, Republic of Korea |
2. Goods consigned to(Consignee's name, address, country)
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3. Notify parties
| 8. For official use |
4. Port of loading
| 5. Port of discharge
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6. Carrier | 7. Date of shipment
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9. Marks & number of package | 10. Numbers and kind of packages; description of goods
| 11. Gross weight or other quantity | 12. Number and date of invoice |
13. Invoice price: | 14. No & date of Export License:
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15. Declaration by the exporter
The undersigned hereby declares that the above details and statements are correct; that all the goods were produced in the Republic of Korea
Place and Date Signature:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of authorized signatory | 16. Certification
We hereby certify that the goods specified above have been duly attested as being of Korean origin.
Signature:
Managing Director korea Chamber of Commerce and Industry |
7. Date of issue | 8. Reference Np. |