ANNEX I
Model of the certificate referred to in Article 2(2)
Text of image
1 Exporter (Name and full address, including Member State)
CERTIFICATE
FOR THE EXPORT
P2
OF PASTA TO THE USA
No
ORIGINAL
2 Consignee (Name and full address)
3 ISSUING AUTHORITY
NOTES
4 Member State of export
A. The original and copies 1, 2 and 3 of this form, boxes 1, 2 and 4 to 8 of which must be completed by the exporter, are endorsed by the issuing authority shown in box 3.
5 Country of destination
B. The original and copies 1 and 2 with the endorsement by the issuing authority shown in box 9 must be presented to the competent customs office in the Community at which the export declaration relating to the goods is lodged.
C. Copy 1 with the endorsement, in box 10, by the customs office referred to under B must be presented to the competent customs authorities in the United States of America.
D. The original with the endorsement, in box 10, by the customs office referred to under B must be sent by the exporter to the paying agency of the Member State of export.
6 Marks and numbers — Number and kind of packages — Description of goods
7 Gross mass (kg)
8 Net mass (kg)
9 ENDORSEMENT BY ISSUING AUTHORITY:
Place and date:
Signature:
Stamp:
10 ENDORSEMENT BY THE COMPETENT CUSTOMS OFFICE IN THE COMMUNITY
This is to certify that for the goods described above (enter where applicable):
a refund rate in conformity with the terms of the EC/USA settlement on pasta shall be requested
no return shall be requested
This is to certify that customs export formalities for the goods describes above have been carried out
Export document:
Type:
Number:
Date of acceptance of declaration:
Customs office:
Member State:
Place and date:
Signature:
Stamp:
Text of image
1 Exporter (Name and full address, including Member State)
CERTIFICATE
FOR THE EXPORT
P2
OF PASTA TO THE USA
No
COPY 1
2 Consignee (Name and full address)
3 ISSUING AUTHORITY
NOTES
4 Member State of export
A. The original and copies 1, 2 and 3 of this form, boxes 1, 2 and 4 to 8 of which must be completed by the exporter, are endorsed by the issuing authority shown in box 3.
5 Country of destination
B. The original and copies 1 and 2 with the endorsement by the issuing authority shown in box 9 must be presented to the competent customs office in the Community at which the export declaration relating to the goods is lodged.
C. Copy 1 with the endorsement, in box 10, by the customs office referred to under B must be presented to the competent customs authorities in the United States of America.
D. The original with the endorsement, in box 10, by the customs office referred to under B must be sent by the exporter to the paying agency of the Member State of export.
6 Marks and numbers — Number and kind of packages — Description of goods
7 Gross mass (kg)
8 Net mass (kg)
9 ENDORSEMENT BY ISSUING AUTHORITY:
Place and date: Signature: Stamp:
10 ENDORSEMENT BY THE COMPETENT CUSTOMS OFFICE IN THE COMMUNITY
This is to certify that for the goods described above (enter where applicable):
a refund rate in conformity with the terms of the EC/USA settlement on pasta shall be requested
no return shall be requested
This is to certify that customs export formalities for the goods describes above have been carried out
Export document:
Type:
Number:
Date of acceptance of declaration:
Customs office:
Member State:
Place and date:
Signature:
Stamp:
Text of image
1 Exporter (Name and full address, including Member State)
CERTIFICATE
FOR THE EXPORT
P2
OF PASTA TO THE USA
No
COPY 2
2 Consignee (Name and full address)
3 ISSUING AUTHORITY
NOTES
4 Member State of export
A. The original and copies 1, 2 and 3 of this form, boxes 1, 2 and 4 to 8 of which must be completed by the exporter, are endorsed by the issuing authority shown in box 3.
5 Country of destination
B. The original and copies 1 and 2 with the endorsement by the issuing authority shown in box 9 must be presented to the competent customs office in the Community at which the export declaration relating to the goods is lodged.
C. Copy 1 with the endorsement, in box 10, by the customs office referred to under B must be presented to the competent customs authorities in the United States of America.
D. The original with the endorsement, in box 10, by the customs office referred to under B must be sent by the exporter to the paying agency of the Member State of export.
6 Marks and numbers — Number and kind of packages — Description of goods
7 Gross mass (kg)
8 Net mass (kg)
9 ENDORSEMENT BY ISSUING AUTHORITY:
Place and date: Signature: Stamp:
10 ENDORSEMENT BY THE COMPETENT CUSTOMS OFFICE IN THE COMMUNITY
This is to certify that for the goods described above (enter where applicable):
a refund rate in conformity with the terms of the EC/USA settlement on pasta shall be requested
no return shall be requested
This is to certify that customs export formalities for the goods describes above have been carried out
Export document:
Type:
Number:
Date of acceptance of declaration:
Customs office:
Member State:
Place and date:
Signature:
Stamp:
Text of image
1 Exporter (Name and full address, including Member State)
CERTIFICATE
FOR THE EXPORT
P2
OF PASTA TO THE USA
No
COPY 3
2 Consignee (Name and full address)
3 ISSUING AUTHORITY
NOTES
4 Member State of export
A. The original and copies 1, 2 and 3 of this form, boxes 1, 2 and 4 to 8 of which must be completed by the exporter, are endorsed by the issuing authority shown in box 3.
5 Country of destination
B. The original and copies 1 and 2 with the endorsement by the issuing authority shown in box 9 must be presented to the competent customs office in the Community at which the export declaration relating to the goods is lodged.
C. Copy 1 with the endorsement, in box 10, by the customs office referred to under B must be presented to the competent customs authorities in the United States of America.
D. The original with the endorsement, in box 10, by the customs office referred to under B must be sent by the exporter to the paying agency of the Member State of export.
6 Marks and numbers — Number and kind of packages — Description of goods
7 Gross mass (kg)
8 Net mass (kg)
9 ENDORSEMENT BY ISSUING AUTHORITY:
Place and date:
Signature:
Stamp:
10 ENDORSEMENT BY THE COMPETENT CUSTOMS OFFICE IN THE COMMUNITY
This is to certify that for the goods described above (enter where applicable):
a refund rate in conformity with the terms of the EC/USA settlement on pasta shall be requested
no return shall be requested
This is to certify that customs export formalities for the goods describes above have been carried out
Export document:
Type:
Number:
Date of acceptance of declaration:
Customs office:
Member State:
Place and date:
Signature:
Stamp:
