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Domond Deolsr 6 onufocturr
Diamond Origin Attestation
Importer:West Africa Diamonds Ltd
Address:tuval 21 Ramat Gan
HAWB#:
Statement
On behalf of West Africa Diamonds, I hereby attest that this shipment does not contain any
diamonds that were in Russia prior to March 1, 2024 (size 1 carat or larger) or before
September 1, 2024(0.5 carat or larger).
This shipment contains:
E Rough diamond(s) greater than or equal to 1 carat
olished diamond(s) greater than or equal to 1 carat.
I confirm that the contents of this attestation are accurate. I acknowledge that failure to comply
may result in seizure of the goods and related measures under the Special Economic Measures
Act and/or Customs Act, where applicable.
Rami PoIatu(
(Print pVe)
(Sinatur41.
9
20.05.2025
(Date)
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To support my attestation, I have included the following documentation to confirm that
diamonds of unknown or Russian origin contained in this shipment were exported from Russia
to a third country before March 1, 2024, (equal to or greater than 1 carat) or before September
1, 2024 (equal to or greater than 0.5 carat):
For rough diamonds For polished diamonds
] Date-stamped Kimberley Process Sorting memo
Certificate Grading report
] G7 Certificate Invoice and transport
] Invoice and transport documentation
documentation Proof of inheritance
] Proof of inheritance GF certificate
] Audited stock / inventory account Extracts from traceability reports
report Other:
i Other:
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To support my attestation, I have included the following documentation along with my
declaration form to confirm non-Russian origin of the diamonds contained in this shipment.
For rough diamonds For polished diamonds
] Kimberley Process Certification Invoice
] Kimberley Process Certificate Packing list
with single origin (non Laboratory grading report
Russian) Transport documentation
] Kimberley Process Certificate Audited stock / inventory account
Mixed Origin associated with report
De Beers Diamond Trading -j G7 Certificate
Company (with invoice ] Other:
statement from De Beers)
] Kimberley Process Certificate
Mixed Origin with additional
evidence demonstrating non-
Russian origin (for example,
transport document, waybill,
invoice)
] G7 Certificate
] Other: