REPUBLIC OF IRAQ

REQUEST FOR CERTIFICATE

1. Trade Parties & Place of Inspection

Seller (Exporter): name and address Buyer (Importer and /or intermediate): name and address

Telephone: Telephone:
Fax: Fax:
Email: Email:
Contact name: Contact name:
Manufacturer / Supplier (if different from seller): name and Location where goods are available for inspection:
address Address:
Contact name:
Telephone: Fax:
Telephone: Email:
Fax: Expected date of shipment:
Email: Date of availability of goods:
Contact name:
Consignment: FCL : x20 FCL x40FCL
Type of delivery: Total Partial Final FCL could be on truck
Details: LCL: Bulk General Cargo/Conventional
trucks (size/volume: )

2. Proforma Invoice / Contract Purchase Order

Number: Currency: Freight value (If applicable)
Date: Total Value Insurance value (If applicable)
Incoterm: FOB Value Other value ((If applicable)

3. Information on Goods
Goods description: (Please attach list of products (proforma invoice)
Goods conditions: New Second hand/Used Complete Complete knock down Semi knock down

4. ICIGI Program
Goods subject to ICIGI Program: Not subject*
(*Do not fill the followings if not subject to ICIGI program)
Please provide copies of conformity documents related to the exported products (Test reports, reports of analysis,
certificates) and any other document demonstrating conformity of the exported goods to Iraqi requirements
ISO 9001 Certificate: Yes No Other Certification :
Test Report provided: Yes No Testing done by: Own lab Third party lab
Certificates provided: Yes No BV Registration No (if any).:
Applicable standards (if Known):
Lab information: ISO 17025 accreditation Yes No Other:

5. Shipment Method and Points of Entry (Information on Points of Entry Is Mandatory):

Air Bagdad airport Al-Basra airport Al-Najaf airport Al-Mosul airport
Sea/river Umm Qasr port Khor Abd Allah port Khor Al-Zubair port Abu Floos port Al-Maaqal port
Road Bagdad Train station
Syria Rabeaa (Mosul) Syria Al-Waleed (Ramadi)
Jordan Trabeel (Ramadi)
Kuwait Safwan (Basra)
Iran Shalamcha (Basra) Iran Badra (Wasit) Iran Al- Muntheryah (Diyala) Iran Al-sheeb
Iran Zarbatiya
The following points of entry are located in Kurdistan province :
Air Erbil airport Al-Sulaymaniyah airport
Road Turkey Ibrahim El-Khalil
Iran Bashmakh (Banja in) Iran Barwizkhan Iran Sartak Iran Sarian Band
Iran Tawella Iran Kelle Iran Hajj Omran
Other point of entry - please specify:
Note: Goods shall be quickly delivered after issuance of the ICIGI Certificate. Expiry dates (if any), remaining shelf life and validity of test
reports shall be in compliance with applicable standards at the date of arrival (refer to applicable standards and Notice to Exporters - 1 for
further details)

6. Affidavit of the Applicant

I hereby declare that the above information and all supporting documents are true and complete in every respect. I undertake to
only ship to Iraq goods (i) specifically identified in the certificate issued by Bureau Veritas (description, brand/manufacturer name,
quantity and, as applicable, productions-expiry dates, batch number) and (ii) compliant and consistent with the conformity
documents I provided. I hereby authorize Bureau Veritas to disclose to the authorities any and all information regarding my
Request for Certificate.
Applicant name: Title:
Company: If different from above:
Signature: Email:
Date: telephone:

IQ REQUEST FOR CERTIFICATE FORM 1/2

Edition: 1.9
 REPUBLIC OF IRAQ
REQUEST FOR CERTIFICATE

Bureau Veritas is available to provide additional information regarding the ICIGI Program for the Republic of Iraq. If you have any comments/complaints/appeals
regarding our services, please notify us at: gsit@bureauveritas.com.
This Request for Certificate is expressly subject to all applicable COSQC KSQCA (as the case may be) regulations and requirements and to the
Bureau Veritas General Conditions of Services which are available upon request sent to: gsit@bureauveritas.com.

IQ REQUEST FOR CERTIFICATE FORM 2/2

Edition: 1.9