Information on the suspected counterfeit merchandise:
‐ Nature of merchandise:
‐ Trade description:
‐ HS Heading Number:3
‐ Origin: 3
‐ Provenance: 3
‐Distinctive elements identifying the suspected counterfeit merchandise: 4
‐Country of production: 3
‐ Name and address of supplier: 3
‐ Other useful information: 3
Attachments:
‐Undertaking
‐Other documents:
Done at ………........... (place),....................................... (date)
Stamp and signature
__________________________________________________________________________
3
If the information is available.
4
Attach documents (catalogs, photographs, brochures, etc.).