ANNEX 7

Original (Duplicate/Triplicate)

Reference No.
1. Goods consigned from (Exporter's business name, ASEAN TRADE IN GOODS AGREEMENT/
address, country) ASEAN INDUSTRIAL COOPERATION SCHEME
CERTIFICATE OF ORIGIN
(Combined Declaration and Certificate)

2. Goods consigned to (Consignee's name, address, FORM D

country) Issued in ______________
(Country)
See Overleaf Notes

3. Means of transport and route (as far as known) 4. For Official Use

Departure date Preferential Treatment Given Under ASEAN

Trade in Goods Agreement

Vessel's name/Aircraft etc. Preferential Treatment Given Under ASEAN

Industrial Cooperation Scheme

Preferential Treatment Not Given (Please

Port of Discharge state reason/s)

..................................................................................
Signature of Authorised Signatory of the Importing
Country
5. Item 6. Marks and 7. Number and type of 8. Origin criterion 9. Gross 10. Number and
number numbers on packages, description of (see Overleaf weight or date of
packages goods (including quantity Notes) other quantity invoices
where appropriate and HS and value
number of the importing (FOB)
country)

11. Declaration by the exporter 12. Certification

The undersigned hereby declares that the above It is hereby certified, on the basis of control
details and statement are correct; that all the goods carried out, that the declaration by the
were produced in exporter is correct.

.............................................................
(Country)
and that they comply with the origin requirements
specified for these goods in the ASEAN Trade in
Goods Agreement for the goods exported to

.............................................................
(Importing Country)

............................................................. ................................................................................
Place and date, signature of Place and date, signature and stamp of
authorised signatory certifying authority

13
□ Third Country Invoicing □ Exhibition

□ Accumulation □ De Minimis

□ Back-to-Back CO □ Issued Retroactively

□ Partial Cumulation

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OVERLEAF NOTES

1. Member States which accept this form for the purpose of preferential treatment under the ASEAN Trade in Goods Agreement
(ATIGA) or the ASEAN Industrial Cooperation (AICO) Scheme:
BRUNEI DARUSSALAM CAMBODIA INDONESIA
LAO PDR MALAYSIA MYANMAR
PHILIPPINES SINGAPORE THAILAND
VIETNAM

2. CONDITIONS: The main conditions for admission to the preferential treatment under the ATIGA or the AICO Scheme are
that goods sent to any Member States listed above must:
(i) fall within a description of products eligible for concessions in the country of destination;
(ii) comply with the consignment conditions in accordance with Article 32 (Direct Consignment) of Chapter 3 of the
ATIGA; and
(iii) comply with the origin criteria set out in Chapter 3 of the ATIGA.
3. ORIGIN CRITERIA: For goods that meet the origin criteria, the exporter and/or producer must indicate in Box 8 of this Form,
the origin criteria met, in the manner shown in the following table:

Circumstances of production or manufacture in the first country Insert in Box 8

named in Box 11 of this form
(a) Goods wholly obtained or produced in the exporting Member “WO”
State satisfying Article 27 (Wholly Obtained) of the ATIGA
(b) Goods satisfying Article 28 (Non-wholly obtained) of the
ATIGA
• Regional Value Content Percentage of Regional Value Content,
example “40%”
• Change in Tariff Classification The actual CTC rule, example “CC” or
“CTH” or “CTSH”
• Specific Processes “SP”

• Combination Criteria The actual combination criterion,

example “CTSH + 35%”
(c) Goods satisfying paragraph 2 of Article 30 (Partial Cumulation) “PC x%”, where x would be the
of the ATIGA percentage of Regional Value Content of
less than 40%, example “PC 25%”

4. EACH ARTICLE MUST QUALIFY: It should be noted that all the goods in a consignment must qualify separately in their own
right. This is of particular relevance when similar articles of different sizes or spare parts are sent.
5. DESCRIPTION OF PRODUCTS: The description of products must be sufficiently detailed to enable the products to be
identified by the Customs Officers examining them. Name of manufacturer and any trade mark shall also be specified.
6. HARMONISED SYSTEM NUMBER: The Harmonised System number shall be that of in ASEAN Harmonised Tariff
Nomenclature (AHTN) Code of the importing Member State.
7. EXPORTER: The term “Exporter” in Box 11 may include the manufacturer or the producer.
8. FOR OFFICIAL USE: The Customs Authority of the importing Member State must indicate (√) in the relevant boxes in column
4 whether or not preferential treatment is accorded.
9. MULTIPLE ITEMS: For multiple items declared in the same Form D, if preferential treatment is not granted to any of the
items, this is also to be indicated accordingly in box 4 and the item number circled or marked appropriately in box 5.
10. THIRD COUNTRY INVOICING: In cases where invoices are issued by a third country, “the Third Country Invoicing” box
should be ticked (√) and such information as name and country of the company issuing the invoice shall be indicated in box 7.
11. BACK-TO-BACK CERTIFICATE OF ORIGIN: In cases of Back-to-Back CO, in accordance with Rule 11 (Back-to-back CO) of
Annex 8 of the ATIGA, the “Back-to-Back CO” box should be ticked (√).
12. EXHIBITIONS: In cases where goods are sent from the exporting Member State for exhibition in another country and sold
during or after the exhibition for importation into a Member State, in accordance with Rule 22 of Annex 8 of the ATIGA, the
“Exhibitions” box should be ticked (√) and the name and address of the exhibition indicated in box 2.
13. ISSUED RETROACTIVELY: In exceptional cases, due to involuntary errors or omissions or other valid causes, the Certificate
of Origin (Form D) may be issued retroactively, in accordance with paragraph 2 of Rule 10 of Annex 8 of the ATIGA, the
“Issued Retroactively” box should be ticked (√).
14. ACCUMULATION: In cases where goods originating in a Member State are used in another Member State as materials for
finished goods, in accordance with paragraph 1 of Article 30 of the ATIGA, the “Accumulation” box should be ticked (√).
15. PARTIAL CUMULATION (PC): If the Regional Value Content of the material is less than forty percent (40%), the Certificate of
Origin (Form D) may be issued for cumulation purposes, in accordance with paragraph 2 of Article 30 of the ATIGA, the
“Partial Cumulation” box should be ticked (√).
16. DE MINIMIS: If a good that does not undergo the required change in tariff classification does not exceed ten percent (10%) of
the FOB value, in accordance with Article 33 of the ATIGA, the “De Minimis” box should be ticked (√).

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