# Commission Regulation (EU) No 578/2010 of 29 June 2010 on the implementation of Council Regulation (EC) No 1216/2009 as regards the system of granting export refunds for certain agricultural products exported in the form of goods not covered by Annex I to the Treaty, and the criteria for fixing the amount of such refunds, Division 3: The form shall be completed as follows:

Extent: E+W+S+N.I.

(a) The name and address of the body issuing the certificate shall be entered in box 1. The number of the refund certificate (allocated by the issuing body) shall be entered in box 2 or box 23.
In the case of extracts from a refund certificate, ‘EXTRACT’ in bold font and capitals shall be entered in box 3.
(b) The name and full address of the holder shall be entered in box 4.
(c) The date on which the application for a refund certificate is lodged shall be entered in box 10 and the amount of the security determined in accordance with Article 23 shall be entered in box 11.
(d) The expiry date shall be entered in box 12.
(e) Boxes 13 to 16 shall be deleted.
(f) Boxes 17 and 18 shall be completed on the basis of the amount determined in accordance with Articles 29 to 34.
(g) Box 19 shall be deleted.
(h) Any details provided in the application shall be entered in box 20.
(i) Box 21 shall be completed as set out in the application.
(j) Box 22 shall contain the words: ‘for use from …’, determined in accordance with Article 29 or Article 34.
(k) Box 23 shall be filled in.
(l) Box 24 shall be deleted.

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Source: https://www.legislation.gov.uk/eur/2010/578/annex/VI/division/III/division/3 (the official version)
Page: https://openlegislation.uk/eu-regulation-2010-578/annex-VI/division-III/division-3
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.