Държавен вестник, бр. 29, 2002 г., стр. 53

Б Р О Й  29
Д Ъ Р Ж А В Е Н   В Е С Т Н И К
С Т Р .  53
 APPLICATION FOR A MOVEMENT CERTIFICATE
1. Exporter  (Name, full address, country)
EUR.1
№ A 000.000
See notes overleaf before completing this form.
2. Application for a certificate to be used in
preferential trade between
3. Consignee (Name, full address, country) (Optional)
................................................................................
and
................................................................................
(Insert appropriate countries or groups of countries or territories)
4. Country, group of
5. Country, group
countries or territory in
of countries or
which the products are
territory of
considered as originating
destination
6. Transport details (Optional)
7. Remarks
8. Item number; Marks and numbers; Number and
9. Gross mass (kg)
10. Invoices
    kind of packages (1); Description of goods
 or other measure
(Optional)
 (litres, m3, etc.)
(1) If goods are not packed, indicate number of articles or state « in bulk » as appropriate
DECLARATION BY THE EXPORTER
I, the undersigned, exporter of the goods described overleaf,
DECLARE
that the goods meet the conditions required for the issue of the attached certificate;
SPECIFY
as follows the circumstances which have enable these goods to meet the above conditions:
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SUBMIT
the following supporting documents (1):
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UNDERTAKE  to submit, at the request of the appropriate authorities, any supporting evidence which these authorities
may require for the purpose of issuing the attached certificate, and undertake, if required, to agree to any
inspection of my accounts and to any check on the processes of manufacture of the above goods, carried out
by the said authorities;
REQUEST
the issue of the attached certificate for these goods.
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(Place and date)
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(Signature)
1 For example : import documents, movement certificates, invoices, manufacturer’s declarations, etc., referring to the products used
in manufacture or to the goods re-exported in the same state.
ДЕКЛАРАЦИЯ НА ИЗНОСИТЕЛЯ
Аз, долуподписаният износител на стоките, описани на другата страница,
ДЕКЛАРИРАМ, че стоките отговарят на условията, изисквани за издаването на приложения сертификат,
УТОЧНЯВАМ както следва обстоятелствата, които позволиха тези стоки да отговорят на горните условия:
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ПРИЛАГАМ следните потвърждаващи документи 1 :
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ЗАДЪЛЖАВАМ СЕ да представя, по молба на съответните власти, всякакви потвърждаващи доказателства,
които тези власти могат да изискат за целите на издаване на приложения сертификат, и се задължавам, ако това се
изисква, да се съглася на всяка проверка на производствения процес на горепосочените стоки от страна на спомена-
тите власти;
МОЛЯ за издаване на приложения сертификат за тези стоки.
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(дата и място)
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(подпис)
1 Например: документи за внос, сертификати за движение на стоките, декларация на производителите и др., свързани с
продуктите, използвани в производството, или със стоките, реекспортирани в същата държава.