Załącznik II

Formularze mają wymiary około 210 × 297 milimetrów. Oryginał sporządzony jest na papierze, na którym za pomocą środków mechanicznych lub chemicznych można wykryć każde fałszerstwo.

Formularze drukuje się i wypełnia w języku angielskim.

Oryginał i kopie wypełnia się pismem maszynowym lub odręcznie. W ostatnim przypadku należy je wypełnić atramentem i drukowanymi literami.

Na każdym świadectwie autentyczności w prawej górnej rubryce podany jest numer serii. Kopie mają ten sam numer co oryginał.

1. Exporter (Name and full address)

CERTIFICATE OF AUTHENTICITY

BASMATI RICE

for export to the European Union

2. Consignee (Name and full address)

No (1)

ORIGINAL

issued by (Name and full address of issuing body)

3. Country and place of cultivation

4. FOB value in US dollars

5. Number and date of invoice

6. Marks and numbers — Number and kind of packages — Description of goods (2)

7. Gross weight (kg)

8. Net weight (kg)

9. DECLARATION BY EXPORTER

The undersigned declares that the information shown above is correct.

Place and date:

Signature:

10. CERTIFICATION BY THE ISSUING BODY

It is hereby certified that the rice described above is BASMATI RICE and that the information shown in this certificate is correct.

Place and date:

Signature:

Stamp:

11. CERTIFICATION BY COMPETENT CUSTOMS OFFICE OF COUNTRY OF EXPORT

Customs formalities for export to the European Union of the rice described above have been completed.

Type, number and date of export document: Name and country of customs office:

Signature:

Stamp:

12. FOR COMPETENT AUTHORITIES IN THE UNION

(1) The number of the certificate of authenticity shall be a number of a continuous series given by the country delivering the certificate.

(2) The operator shall specify

— for marks and numbers: the reference and number of the batch

— for number and kind of packages: the number and weight of packages

— for the description of goods: the information on the rice, the CN code as well as the variety or varieties, which shall be on the list provided for in Commission Delegated Regulation (EU) 2023/2835. The description of goods should correspond to the information included in the invoice, the number and date of which is specified in box 5.

N. B.: This certificate is issued in conformity with the national legislation.