1. Exporter (Name and Office 3.Ref. No. ....... address) SOUTHERN AFRICAN DEVELOPMENT COMMUNITY 2. Consignee (Name and Office address) CERTIFICATE OF ORIGIN 4. Particulars of transport: 5. For Official use 6. Marks and numbers; number 7. Customs 8. Origin 9. Gross and kind of package, description tariff No. criterion weight or of goods 11. DECLARATION BY (see other overleaf) quantity 10. Invoice 12. CERTIFICATE OF ORIGIN EXPORTER/SUPPLIER It is hereby certified that the above mentioned goods are I, the undersigned, hereby declare of that the above details and statements are correct and that all ................................................................................................ the goods are produced in ................................................................................................ ................................................... ................................................................................................ ........................... .......................................... Place, date signature of declarant Certificate of Customs or other Designated Authority STAMP