Specimen of the application form referred to in Article 2(2)
ANNEX IISupplementary provisions
ANNEX II Specimen of the application form referred to in Article 2(2) Text of image APPLICATION APPLICATION FORM UNDER COUNCIL REGULATION No 866/2004 No: 00001 Producer (name, or name of firm, and full address): Consignor (name, or name of firm, and full address): Consignee (name, or name of firm, and full address): Description of goods, item number, marks numbers, number and kind of packages (for goods not packed indicate number or in bulk): Volume/quantity Transaction value Net weight (kg)/ other units of measure Declaration by the producer I, the undersigned, declare that the goods described above originate, within the meaning of Articles 23 and 24 of Council Regulation (EEC) No 2913/93, in the areas as defined in Article 1(1) of Protocol No 10 of the Act of Accession 2003, declare that the particulars given in this application are correct, declare that I keep available for control purposes for a time period of at least three years all accounts concerning the production (including the purchase of raw materials) and the sale of the goods, accept that controls can be made at any reasonable time by the Turkish Cypriot Chamber of Commerce, by the phytosanitary experts under Council Regulation (EC) No 866/2004 or by the Commission services. DateSignature Declaration by the consignor The goods mentioned in this application are: Destined for consumption in Cyprus Not destined for consumption in Cyprus. Please specify country of destination: I, the undersigned, apply for the issue of an accompanying document under Council Regulation (EC) 866/2004. DateSignature