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EAC Schedules - 5th Schedule : Form for Verification of Origin
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EAC Schedules
4th Schedule: Declaration by the Producer
5th Schedule: Form for Verification of Origin
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FIFTH SCHEDULE

Rule 12 (4)

FORM FOR VERIFICATION OF ORIGIN

PART A

Particulars of the Goods in Respect of Which Evidence of Origin is Required

1. Certificate Number ………………………………………………………
(Copy must be attached)

2. Production process(es) carried out ………………………………………………………

3. Materials imported from outside the Partner States used in the manufacture of the goods described in the Certificate, their respective customs values and HS Codes ………………………………………………………

4. Materials of East African Community origin used in the manufacture of the goods described in the Certificate, the respective customs value and HS Codes ………………………………………………………

5. Containers or other forms of interior packing normally sold with the goods at retail level or the materials used in their manufacture, their origin customs values and HS Codes ………………………………………………………

6. Import duty, if any, paid on the materials imported from outside the Partner States ………………………………………………………

7. Direct labour costs and factory overheads ………………………………………………………

8. Ex-factory costs of the goods produced ………………………………………………………

9. The cost of exterior packing ………………………………………………………

10. Profit mark-up on the goods produced ………………………………………………………

11. The wholesale price of the goods in the country of manufacture ………………………………………………………

………………………………………………………………….

Declaration

I …………………………………………………………………………………………
(Name and Designation)

of ……………………………………………………………………………………….
(Name of the Firm)

…………………………………………………………………………………………..
(Physical Location)

…………………………………………………………………………………………..
(Address)

declare that the above details and statements are correct and that they are furnished in cognizance of the requirements of the Rules of Origin.

 

PART B

Certification

It is hereby certified, on the basis of control carried out that the declaration by the exporter is correct

…………………………………………………………………………………………………………………………………………………
(Place and Date)

………………………………………………………………………………………

Name & Signature

STAMP