CERTIFICATE OF ORIGIN

EXPORTER CERTIFICATE No.

___________________________________ ____________________
___________________________________ EXPORTER REFERENCE
___________________________________ ________________
___________________________________
___________________________________
CONSIGNEE BUYER (IF NOT CONSIGNEE)
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
FORWARDING AGENT/MERCHANT
___________________________________ CERTIFICATE OF AUSTRALIAN ORIGIN
___________________________________ _______________________________________
___________________________________ _
___________________________________ _______________________________________
RECEIVING DATE DOCK CONT BASE _
________________ ________________ _______________________________________
VESSEL/AIRCRAFT VOYAGE _
__________________________ ________
No
_______________________________________
PORT OF LOADING DATE OF DEPARTURE
____________________ ________________ _
PORT OF DISCHARGE FINAL DESTINATION Authorised to issue certificate of origin by
____________________ ____________________ the Government of the Commonwealth of Australia

MARKS, Nos AND CONTAINER No; No AND KIND OF PACKAGES; DESCRIPTION OF GOODS
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Void unless endorsed by the Australian Chamber of Commerce or its authorised

I,the undersigned, being duly authorised by the I,the undeersigned, being duly authorised by
above exporter, and having made the neccessary teh Australia Chamber of Commerce to sign
enquiries hereby certify that based on the rules of documentary evidence of origin, hereby certify
origin of the country of destination (printed on the that on the basis of informaion supplied by the
reverse hereof (1) all the goods listed above Chamber Stamp
or Logo exporter and to the base of my knowledge and
originate in AUSTRALIA. I further declare that I belief the country of origin of hte above
will furnish to the Customs authorities of the mentioned goods, based on the rules of origin
imposing country of their worthness, for claimed by the exporter, is AUSTRALIA.
inspection at any time such evidence as may be
requested for the purpose of verifying this ACN:
certificate. The goods were produced / Issued at ............................
manufactured at by the ..................................
______________________________ (2) Chamber of Commerce which
(1) delete the inapplicable phrase for this purpose is Agent for the SIGNATURE OF AUTHORISED OFFICER
(2) insert place of production/manufature Australian Chamber of
Commerce.
SIGNATURE OF AUTHORISED OFFICER DATE

(C) Silicon Crafts Pty Ltd - 1998 ANZ Export Book Crafted for Victoria University