DECLARATION OF ORIGIN
truncated fileFOR THE EXPORT OF GOODS (SPECIFIED IN THE
NOTE BELOW) TO THE REPUBLIC OF SOUTH
AFRICA
(Section 46 of the Customs and Excise Act, 1964, and the rules
thereto)
DA 59
Note to Importers:
This declaration, properly completed by the supplier and signed by the authority responsible for certification thereof, must be furnished in support of goods exported to the Republic of South Africa which are subject to anti-dumping, countervailing or safeguard duties prescribed in Schedule No. 2 of the Act, or in respect of which import restrictions are imposed in South Africa against imports from a specific
country or countries, and are imported from a country other than that for which the duty and / or import restriction is imposed.
Supplier (Name, address, country) Consignee (Name, address, country)
Particulars of transport (Insert voyage no., etc.)
1 Item No
2
Marks &
Numbers
3
No & Description
of packages
4
Description of goods
5
Country of
origin
6
Gross Mass
7
Invoice No
Reference
DECLARATION:
I, the undersigned, duly authorized by …………………………………………………………………………..
(insert name of supplier), certify that the goods described above originate in the country shown in column 5 in accordance with the requirements of paragraph * 1 / *2 (*delete whichever is not applicable and sign in full).
* 1. The goods enumerated opposite item(s) ……………………………………………… in column 1 above have been wholly produced or manufactured in the country stated in column 5 in respect of such goods from raw materials produced in that country.
*2. The goods enumerated opposite item(s) ………………………………………………. in column 1 above have been wholly or partly manufactured from imported materials in the country specified in column 5 of such goods; and
(a) the final process of manufacture has taken place in the said country;
(b) the cost to the manufacturer of the materials wholly produced or manufactured in the said country plus the cost of labour
directly employed in the manufacture of such goods is not less than ……….. per cent of the total production cost of
such goods;
(c) in calculating the production cost of such goods only the cost to the manufacturer of all materials, wages and salaries,
direct manufacturing expenses, overhead factory expenses, cost of inside containers and other expenses used or expended in the manufacture of such goods have been included and charges for outside packages, profits and administrative,
distribution and selling overhead expenses, and other charges incurred subsequent to the completion of the manufactured goods, have been excluded.
…………………………………………………………
Place of issue ………………………………………………………….
Date
…………………………………………………….
Full name and capacity (print) …………………………………………………………
Signature
Certificate of authority responsible for certification of this declaration.
The declaration by the supplier has been verified and found correct.
…………………………………………………………………………………………………………………
Place and date Full name and capacity (print) Signature Stamp of Authority

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