DODATEK 3

STANDARDOWY FORMULARZ OŚWIADCZENIA WŁASNEGO DOTYCZĄCEGO POCHODZENIA PRZYWOŻONEGO DREWNA

Niniejszy standardowy formularz jest dwujęzyczny (w języku angielskim i wietnamskim) i jest wypełniany w języku wietnamskim.

Niniejsze oświadczenie własne jest wymagane w odniesieniu do wszystkich dostaw przywożonego drewna nieposiadających zezwolenia CITES, zezwolenia FLEGT lub równoważnego zezwolenia na wywóz obejmującego całą dostawę, wystawionego przez państwo wywozu, które zawarło dobrowolną umowę o partnerstwie z Unią i posiada funkcjonujący system zezwoleń FLEGT. Oświadczenie własne przedkłada się wraz z odpowiednią dokumentacją celną. Wypełnia się je zgodnie z mającymi zastosowanie przepisami wietnamskimi i wytycznymi dotyczącymi wdrażania VNTLAS.

Dokument ten ma zastosowanie zarówno do organizacji, jak i do gospodarstw domowych przywożących drewno do Wietnamu (zwanych dalej „importerem”) w celu zapewnienia, aby przywożone drewno było legalnie pozyskane, wyprodukowane i wywiezione zgodnie z odpowiednimi przepisami obowiązującymi w kraju pozyskania.

A. General information

1. Name and address of importer:

2. Name and address of exporter:

3. Goods description:

4. HS code:

5. Species scientific name:

6. Species trade name:

7. Goods quantity (m 3 /kg/pieces/packaging):

8. Bill of lading number (B/L):

9. Invoice number:

10. Packing list reference (if available):

11. Exporting country:

12. Country of harvest:

B. Risk status of imported shipment

According to the status of the shipment, please check the applicable box below:

 B1. Low-risk species and of low-risk geographic origin – no additional documentation required; go to Section D below.

 B2. High-risk species and/or of high-risk geographic origin – additional documentation required; go to Section C and Section D below.

C. Additional documentation

C1. Primary products (e.g. HS Codes 4403, 4406, 4407)

If the timber products are made from high-risk species and/or are of high-risk geographic origin (B2), please attach to this self-declaration form one of the following verifiers for legal harvesting:

C1.1 Voluntary certification or national certification scheme recognised by the VNTLAS:

Certification scheme (name and type) Certificate claim number Validity until





C1.2 Harvesting permit/document:

Type of document Document reference/number Issue date Issuing authority/entity Comments





C1.3 Where the country of harvest does not require a harvesting document for the forest area this product is originating from, please provide the following additional information:

Type of document Document reference/number Issue date Issuing entity Comments Country of harvest: Name and address of supplier: Reason the harvesting document is not required:

 Separate sheet with details of the species and volumes attached

C1.4 Where the harvesting document for this product is not available, please provide the following additional information:

Type of alternative to harvesting document Document reference number Issue date Issuing entity Comments Country of harvest: Name and address of supplier: Reason the harvesting document is not available

 Separate sheet with details of the species and volumes attached

C2. Complex products (e.g. HS Chapters 44 and 94 excluding HS Codes 4403, 4406 and 4407)

If the timber products are made from high-risk species and/or are of high-risk geographic origin (B2), please attach to this self-declaration form one of the following verifiers for timber legality:

C2.1 Voluntary certification or national certification scheme recognised by the VNTLAS:

Certification scheme (name and type) Certificate claim number Valid until





C2.2 Where the harvesting permit/document is not available:

Type of document demonstrating legality Document reference number Issue date Issuing entity Comments Where the product came from: Name and address of supplier/exporter: Alternative additional documentation demonstrating legality of timber in accordance with the legislation of the country of harvest:

 Separate sheet with details of the species and volumes attached

D. Additional measures by the importer to mitigate any risk related to the legality of the timber in accordance with the relevant legislation in the country of harvest:

D 1.1 Information on legal requirements for timber export in the country of harvest

Identify any legal requirements (e.g. export bans, export licensing requirements, etc.) for timber export applicable to particular product or species per country of harvest for each product

Product, species and country of harvest Legal requirements for timber export Evidence of compliance

D 1.2 Risk identification and mitigation

Identify any risk of illegally harvested and traded timber related to the shipment in accordance with the relevant legislation in the country of harvest and indicate mitigation measures applied. Continue on a separate sheet if necessary.

Risks identified Mitigation measures applied

Declaration by the importer: I declare that the information given in this form is true, complete and accurate.