1. Exporter (name, full address, country) 3. Consignee (name, full address, country) (Optional) 6. Transport Details (Optional)	EUR. 1 TO N.C See notes overleaf before completing this form. 2. Certificate used in preferential and (Insert appropriate countries, groups of countries or territories) 4. Country, group of countries or territory in which the products are considered as originating 5. Country, group of countries or territory of destination 7. Remarks (Optional)
8. Item number, Marks and numbers, Number and kind of packages (1), Description of goods 9. Gross weight (Kg) 10. Invoices (Optional)
11.VISTO DELLA DOGANA 12.DICHIARAZIONE DELL'ESPORTATORE Dichiarazione certificata conforme Io sottoscritto dichiaro chele merci di cui sopra soddisfano alle condizioni richieste per ottenere il presente certificato Documento d'esportazione modello n. del Ufficio doganale: Paese o territorio in cui il certificato é rilasciato: Fatto a ,addì A ,addì
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