ANNEX 5

CERTIFICATE OF ORIGIN

1. Exporter (business name, address and 4. No. ________

country)
EAEU-VN FTA
Certificate of Origin
Form EAV
2. Importer/Consignee (business name,
Issued in
address and country)
________________________________________
(country)

For submission to
________________________________________
(country)

3. Means of transport and route (as far as 5. For official use

known)

6. Item No. 7. Number 8. Description 9. Origin criterion 10. Quantity 11. Number
and kind of goods of goods and date of
of invoice
packages

12. Certification 13. Declaration by the applicant

It is hereby certified, on the basis The undersigned hereby declares

of control carried out, that the that the above details are correct,
declaration by the applicant is correct. that all goods were produced in

____________________________________
(country)

and that they comply with the rules of origin

as provided for in Chapter 4 (Rules of Origin)
of the EAEU-VN FTA

Place Date Signature Stamp Place Date Signature Stamp

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Additional Sheet of Certificate of Origin (Form EAV) No. ___

6. Item No. 7. Number 8. Description 9. Origin 10. Quantity 11. Number

and kind of goods criterion of goods and date of
of packages invoice

12. Certification 13. Declaration by the applicant

It is hereby certified, on the basis The undersigned hereby declares

of control carried out, that the that the above details are correct,
declaration by the applicant is correct. that all goods were produced in

_____________________________
(country)

and that they comply with the rules of origin

as provided for in Chapter 4 (Rules of Origin)
of the EAEU-VN FTA

Place Date Signature Stamp Place Date Signature Stamp

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Instructions for Completing Certificate of Origin (Form EAV)

The Certificate of Origin (Form EAV) and its additional sheets must be on ISO
A4 size colour paper in conformity with the specimen shown in this Annex. It
shall be made in the English language.

Unused spaces in boxes 6 through 11 shall be crossed out to prevent any

subsequent addition.

The Certificate of Origin shall:

a) be in a hard copy and in conformity with the specimen text set out in
this Annex, which shall be printed in the English language;

b) contain the minimum data required in boxes 1, 2, 4, 7 through 13;

c) bear a signature of an authorised signatory and official seal of the

authorised body and security features. The signature shall be
handwritten and official seal shall not be a facsimile.

Box 1: Enter details of the exporter of the goods: business name, address and
country.

Box 2: Enter details of the importer of the goods (obligatory) and consignee (if
known): business name, address and country.

Box 3: Enter details of transportation (as far as known) such as departure

(shipment) date, means of transport (vessel, aircraft, et cetera), place (port,
airport) of discharge.

Box 4: Enter details of unique reference number, issuing country and country to
be submitted to.

Box 5: Enter the words:

“DUPLICATE OF THE CERTIFICATE OF ORIGIN

NUMBER___DATE___” in case of replacement of the original Certificate of
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Origin.
“ISSUED IN SUBSTITUTION FOR THE CERTIFICATE OF ORIGIN
NUMBER___DATE___” in case of substitution of the original Certificate of
Origin.
“ISSUED RETROACTIVELY” in exceptional cases, where a Certificate of
Origin has not been issued prior to or at the time of exportation.

Box 6: Enter the item number.

Box 7: Enter the number and kind of packages.

Box 8: Enter the detailed description of goods including HS 6-digit code of the
importing Party and, if applicable, model and brand name in such a way as to
enable them to be identified.

In an exceptional case where the invoice issued in a third country is not available
at the time of issuance of the Certificate of Origin, the invoice number and the
date of the invoice issued by the exporter to whom the Certificate of Origin is
issued should be indicated and it should be indicated that the goods will be
subject to another invoice to be issued in a third country for the importation into
the importing Party, identifying the full legal name and address of the company
or person that will issue another invoice in the third country. In such case, the
customs authorities of the importing Party may require the importer to provide
the invoices and any other relevant document which confirms the transaction
from the exporting Party to the importing Party, with regard to the goods declared
for import.

If the goods satisfy a description of footwear made of leather for use in indoor
and outdoor sporting activities (ex 6403 91, 6403 99) stipulated in Annex 1 to
this Agreement the mark “Sporting Footwear” shall be indicated.

Box 9: Enter the origin criteria for all goods in the manner shown in the
following table:
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Origin criterion Insert in

Box 9
(a) Goods wholly obtained or produced in a Party as provided for in Article
WO
4.4 of this Agreement
(b) Goods produced entirely in the territory of one or both Parties,
PE
exclusively from originating materials from one or both Parties
(c) Goods produced in the territory of a Party using non-originating material
PSR
and satisfies the requirements as specified in Annex 3 to this Agreement

Box 10: Enter the quantity of goods: gross weight (kg) or other measurement
(pcs, liters, et cetera). The actual weight of delivered goods shall not exceed five
percent of the weight specified in the Certificate of Origin.

Box 11: Enter the invoice number(s) and date(s) of invoice(s) submitted to an
authorised body for the issuance of the Certificate of Origin.

In cases where invoices are issued by a third country, such information as a mark
“TCI”, name and country of the company issuing the invoice shall be indicated.

Box 12: Enter the place and date of issuance of the Certificate of Origin,
signature of an authorised signatory and impression of stamp of the authorised
body.

Box 13: Enter the origin of goods (Viet Nam or a Member State of the Eurasian
Economic Union), place and date of declaration, signature and impression of
stamp of the applicant.

For the purposes of the Certificate of Origin (Form EAV),

“EAEU-VN FTA” means the Free Trade Agreement between the Socialist
Republic of Viet Nam, of the one part, and the Eurasian Economic Union and its
Member States, of the other part.