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XXXXXXX LIMITED
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Address
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APPENDIX B
EXPORTERS STATEMENT OF ORIGIN
I certify that the goods
described in this invoice or in the attached invoice no. XXX/2017 was produced in the beneficiary country of BANGLADESH and that at least 100 % of the ex-factory price of the
goods originates in the beneficiary country/ countries of BANGLADESH.
(Managing
Director)
Name & Title
Corporation Name
& Address
Telephone & Fax
Numbers
10/10/2017
Signature & Date
(Day/Month/Year)
