1. Exporter (name, full address,country)

A.TR. No. A (123456)
2. Transport document (Optional)

No. Date
3. Consignee (Name, full address, country) (Optional)

4.

ASSOCIATION

between the

EUROPEAN ECONOMIC COMMUNITY

and

TURKEY

5. Country of exportation

6. Country of destination (1)

7. Transport details (Optional)

8. Remarks

9. Item

num-

ber

10. Marks and numbers: Number and kind of packages (for goods in bulk, indicate the name of the ship or the numer of the

railway wagon or road vehicle); Description of goods

11. Gross weight kg or other measure

(hl, m3, etc.)

12. CUSTOMS ENDORSEMENT

13. DECLARATION BY THE EXPORTER

I, the undersigned, declare that the goods

described above meet the conditions required

for the issue of this certificate.

(Place and date)

(signature)

(1) Insert the Member State of Turkey

1 Consignee Avsändare

helena

2009-12-10

Receptionen