Appendix XI

APPLICATION TO BECOME A REGISTERED EXPORTER 1. Exporter’s name, full address and country (Non Confidential) 2. Contact details including telephone and fax number as well as e-mail address where available (Confidential) 3. Description of your activities, specifying whether your main activity is producing or trading (Non Confidential) and, where applicable, industrial process (Confidential). 4. Indicative description of goods which qualify for preferential treatment, including indicative list of Harmonised System four-digit headings (or chapters where goods traded fall within more than twenty Harmonised System headings). 5. Undertaking by exporter The undersigned hereby declares that the above details are correct and: certifies not to have had a previous registration withdrawn and, should this be the case, certifies to have remedied the situation which led to such withdrawal; undertakes to make out statements on origin only for goods which qualify for preferential treatment and comply with the origin rules specified for those goods in this Annex; undertakes to maintain appropriate commercial accounting records for production/supply of goods qualifying for preferential treatment and to keep them for at least three years from the date of making out of the statement on origin; undertakes to accept any control on the accuracy of his statements on origin, including verification of accounting records and visits to his premises by the Commission or Member States’ authorities; undertakes to request his removal from the record of registered exporters should he no longer meet the conditions for exporting any goods under this Decision or no longer intend to export such goods. Place, date and signature of authorised signatory; designation and/or title 6. Prior specific and informed consent of exporter to the publication of his/her personal data on the internet The undersigned is hereby informed that the information supplied may be stored on a database of the Commission and that the particulars may be disclosed to the public via the internet, with the exception of the information which is marked in this application as confidential. He accepts the publication and disclosure of this information via the internet. The undersigned may withdraw his consent to the publication of this information via the internet by sending [electronic mail, fax, written correspondence] to the following address: Place, date and signature of authorised signatory; designation and/or title 7. Box for official use by governmental authority The applicant is registered under the following number: Registered Number: … Date of registration … Period of validity from … Signature and stamp … Important remark to the attention of the applicant: Please note that all data marked ‘non confidential’ will be included in a database accessible to the public; data marked ‘confidential’ will be accessible to your competent governmental authorities and competent authorities of the Union and its Member States

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Source: EUR-Lex (Cellar) · retrieved 2026-11-02 · Text as adopted (Official Journal); later amendments are not incorporated in this text.