APPLICATION FOR CERTIFICATE OF ORIGIN FORM I Exporter Ref. No. Dated To The Director General, Goa Chamber of Commerce & Industry Consignee GCCI Building, P O Box 59 PANJIMGOA Dear Sir, This is to request the favour of your issuing us Certificate of Origin (in ) in respect of the consignment particulars of which are given herewith PreCarriage by Place of Receipt by Pre Carriage Yours sincerely, Vessel/Flight No. Port of Loading Signature of Exporter Port of Discharge (with Office Seal) Final Destination Marks & Nos. Container No & Kind of Pkgs. Description of Goods Quantity Remarks Declaration by Exporter We hereby declare that to the best of our knowledge and belief the above mentioned goods were produced /manufactured in India Signature & Date (With Office Seal)
