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<div id="bkmrk-supplier%27s-declarati">**<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">SUPPLIER'S DECLARATION</span>**

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"></span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">I, the undersigned, declare that the goods listed on this document …………………………….……………….(1), originate in ……………………………….(2) and satisfy the rules of origin governing preferential trade with ……………………………………………(3).</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"></span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">I declare that (4):</span>

<span style=" padding: 0px; margin: 0px; position: relative;"><span style=" padding: 0px; margin: 0px; position: absolute; left: 1px; top: -57px; width: 12px; height: 12px;">  
</span></span><span style=" padding: 0px; margin: 0px; position: relative;"><span style=" padding: 0px; margin: 0px; position: absolute; left: 1px; top: -35px; width: 12px; height: 12px;">  
</span></span><span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"><span style=" padding: 0px; margin: 0px;"> <span> </span></span>Cumulation applied with …………………………………(name country/countries)</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"><span style=" padding: 0px; margin: 0px;"> <span> </span></span>No cumulation applied</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"></span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">I undertake to make available to the customs authorities any further supporting documents they require.</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">……………………………………………………………………….…. (5)</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">………………………………………………………………………….. (6)</span>

<div style=" padding: 0cm 0cm 1pt; margin: 0px; color: rgba(0, 0, 0, 0.85); font-family: lexendregular, sans-serif; font-size: 14px; font-style: normal; font-weight: 400; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; background-color: rgb(245, 245, 245); border-top: none; border-right: none; border-left: none; border-bottom: 1.5pt solid windowtext;"><span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"> ……………………………………………………………………..…… (7)</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;"></span>

</div>*<span lang="EN-US" style=" padding: 0px; margin: 0px; font-size: 12pt; line-height: 17.12px;">Footnotes (can be removed after completion)</span>*

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">(1) If only some of the goods listed on the document are concerned, they shall be clearly indicated or marked and this marking entered in the declaration as follows:</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">“………………..…listed on this document and marked …………………..….originate in ………………….…</span>

<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">(2) T</span>

<div style=" padding: 0px; margin: 0cm 0cm 8pt; width: 1056.08px; float: left; color: rgba(0, 0, 0, 0.85); font-style: normal; font-weight: 400; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; background-color: rgb(245, 245, 245); font-size: 11pt; font-family: Calibri, sans-serif; line-height: 15.6933px;">![](https://acc.bzctrl.com/bzctrl-core-api/api/v1/download/editor_1_5_5ef4454f-7f82-476f-be36-ccb315d95456_drow_20251117T230729248Z.png)<span lang="EN-US" style=" padding: 0px; margin: 0px; line-height: 15.6933px;">![](https://acc.bzctrl.com/bzctrl-core-api/api/v1/download/editor_1_5_157f7d17-d1d9-455a-86d0-6c2ee25f9878_drow_20251117T230807221Z.png)</span></div></div>