Sample Application for Certificate of Exemption

  COMPANY’S LETTER HEAD

Application for Certificate of Exemption

                                                                                  
                                                                                                        _______________________    
                                                                                                                            Date

SENEN M. PERLADA
Director-in-Charge,
International Coffee Organization Certifying Agency
DTI-International Bldg.
375 Sen. Gil Puyat Ave., Makati City

Dear Sir:
We would like to request for a Certificate of Exemption from the issuance of
Coffee Export Clearance and Certificate of Origin  for our sample size coffee
shipment for promotional/personal/other purpose of the following coffee products;
Coffee Form : ________________________________
Brand (if any) : ________________________________
Net Weight
( 60 kgs GBE or less ) : ________________________________
Sender’s Name : ________________________________
Company : ________________________________
Address : ________________________________
Name of Consignee : ________________________________
Company : ________________________________
Address : ________________________________
________________________________

Country of Destination : ________________________________

Attached is our invoice/packing list to support our application. (Optional)
Thank you for your assistance.

Very truly yours,

______________________________  
Name & Position