Appendix V SUPPLIER’S DECLARATION FOR PRODUCTS NOT HAVING PREFERENTIAL ORIGINAL STATUSF1

I, the undersigned, declare that the goods listed on this invoice … ⁽¹⁾

were produced in … ⁽²⁾

and incorporate the following components or materials which do not have EPA, OCT or European Union originating status for preferential trade:

… ⁽³⁾ … ⁽⁴⁾ … ⁽⁵⁾

…

…

… ⁽⁶⁾

I undertake to make available to the customs authorities, if required, evidence in support of this declaration.

… ⁽⁷⁾ … ⁽⁸⁾

… ⁽⁹⁾

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