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ANNEX IU.K.Model of declaration of independence referred to in Article 12

Instructions for completing the declaration

(1)

In block A, fill in the information on the tariff quota to which the declaration of independence applies.

(2)

In block B, tick the applicable box.

(3)

In block C, indicate the operator’s name, EORI number, date and place of signature, and include the signature of the operator’s competent managing (chief executive) officer.

A. Tariff quota concerned U.K.

a

Only to fill in if the origin of the goods is a mandatory element in the licence application.

Tariff quota order number
CN code(s)
Origin of the product(s)a

B. Independence of operator U.K.

The applicant for the tariff quota order number listed above declares:

1.The applicant is not linked, as set out in Article 11 of Delegated Regulation (EU) 2020/760, with other legal or natural persons applying for the same tariff quota order number.
box to be ticked as appropriate.
2.The applicant is linked, as set out in Article 11 of Delegated Regulation (EU) 2020/760, with other legal or natural persons applying for the same tariff quota order number.

The applicant regularly performs substantial economic activities towards third parties within the meaning of Article 11(3).

The applicant has disclosed the natural or legal persons to which it is linked in the LORI electronic system in accordance with Article 11(4).

box to be ticked as appropriate.

C. Operator’s details U.K.

Name
EORI number
Date and place
Signature
Role in the company of the signatory