Annex V A TO PROTOCOL 1 SUPPLIER DECLARATION FOR PRODUCTS HAVING PREFERENTIAL ORIGIN STATUS

I, the undersigned, declare that the goods listed on this invoice …⁽¹⁾ were produced in …⁽²⁾ and satisfy the rules of origin governing preferential trade between the ESA States and the European Community.

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

…⁽³⁾ …⁽⁴⁾ …⁽⁵⁾