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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).
I declare that (4):
Cumulation applied with ?????????????(name country/countries)
No cumulation applied
I undertake to make available to the customs authorities any further supporting documents they require.
???????????????????????????.?. (5)
????????????????????????????.. (6)
??????????????????????????..?? (7)
Footnotes (can be removed after completion)
(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:
???????..?listed on this document and marked ???????..?.originate in ???????.?
(2) The European Union, country, group of countries or territory, from which the goods originate
(3) Country, group of countries or territory concerned
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