[See rule 15(1)]

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....ORIGIN 1. Product consigned from (Exporters‟ Business Name, Address, Country) Reference No. Duty Free Tariff Preference Scheme by India for Least Developed Countries (Combined declaration and certificate) Issued in............................... (Country) (See notes overleaf) 2. Product consigned to (Consignee‟s Name, Address, Country) 4. For Official use ....

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.... products in Duty Free Tariff Preference Scheme by India for Least Developed Countries ............................................. (Importing Country) ................................................ Place and date, name and signature of the authorised signatory 12. Certificate:   It is hereby certified, on the basis of control carried out, that the declaration by the expo....

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.... produced or obtained - (i) enter the letter 'B' in box 8 for products, which meet the origin criteria according to rule 5 of the aforesaid rules. Entry of letter 'B' shall be followed by the percentage of local value added content, as calculated under clause (a) or clause (b) of sub-rule (2) of rule 5 of the said rules: [example B ( ___ ) per cent.]; (ii) enter letter 'C' in box 8 for produ....