APPLICATION FOR CERTIFICATE OF ORIGIN - DOC

							                                    CERTIFICATE OF ORIGIN
                                                   Non-Preferential

Exporter
                                                                                                  No.




Consignee




Pre-Carriage by         Place of Receipt by Pre-Carriage


                                                                              NARAYAN RAJARAM BANDEKAR BHAVAN,
Vessel/Flight No.       Port of Loading                                                      ORMUZ ROAD,
                                                                            OPP. AZAD MAIDAN, P.O.BOX 59, PANJIM – GOA.
                                                                              TELEPHONE : 2424252, FAX (0832) 2425560
                                                                                    Email : goachamber@gmail.com
Port of Discharge       Final Destination                                           Website : www.goachamber.org




Marks & No.s                                                                Quantity                Remarks
Container            No. & Kind of Pkgs.          Description of Goods




                                                        CERTIFICATION
It is hereby ceritified that to the best of our knowledge and belief the above mentioned goods are of Indian Origin.



                                                                     Signature & Date