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ORIGINAL1.Goods consigned from (Exporter's business name, address, country)Reference No.GENERALIZED SYSTEM OF PREFERENCESCERTIFICATE OF ORIGIN(Combined declaration and certificate)2.Goods consigned to (Consignee's name, address, country)FORM AIssued inTHE PEOPLE'S REPUBLIC OF CHINA(country)See Notes overleaf3 Means of transport and route (as far as known)4.For official use5.Item num-ber6.Marks and numbers of packages7.Number and kind of packages; description of goods8.Origincriterion(see Notes overleaf)9.Grossweightor otherquantity10.Numberand date ofinvoices 11.CertificationIt is hereby certified, on the basis of control carried out, that the declaration by the exporter is correct.12.Declaration by the exporterThe undersigned hereby declares that the above details and statements are correct, that all the goods wereproduced inCHINA(country)and that they comply with the origin requirements specified for those goods in the Generalized System of Preferences for goods exported to -Place and date, signature and stamp of certifying authority-Place and date, signature and stamp of authorized signatory