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A p p r o v e d t h r o u g h 12 / 3 1/ 9 6
O MB N o . 15 15 - 0 3 0 4
S e e B a c k o f Fo r m f o r P a p e r -
Wo r k R e d u c t i o n A c t N o t i c e
CERTIFICATE OF ORIGIN
P le a s e p r int o r t y p e
1. E X P OR T ER N A M E A N D A D D R ES S
19 C F R 18 1. 11, 18 1. 2 2
2 . B LA N KE T P ER IO D ( D D / M M / Y Y )
FRO
TO
TA X ID EN TIF IC A TIO N N U M B ER
3 . P R O D U C E R N A M E A N D A D D R ES S
4 . IM P O R T ER N A M E A N D A D D R E S S
T A X ID E N T IF IC A TION N U M B E R :
TA X ID E N T IF IC A TIO N N U M B ER :
6.
7.
HS TA R IF F
P R EF E R EN C E
C LA S S IF IC A T
C R ITER IO N
IO N N U M B ER
5.
D E S C R IP T ION O F G OO D ( S )
8.
PR OD UC ER
9.
N ET C OS T
10 .
C OU NTR Y
O F O R IG IN
I C E R T IF Y T H A T :
T H E IN F O R M A T IO N O N T H IS D O C UM EN T IS TR UE A N D A C C UR A TE A N D I A S S UM E TH E R ES P O N S IB ILITY F O R P R O VIN G S UC H R E
I UN D ER S T A N D TH A T I A M LIA B LE F O R A N Y F A LS E S T A T EM E N T S O R M A TE R IA L O M IS S IO N S M A D E O N O R IN C O N N E C T IO N W
I A G R E E TO M A IN T A IN , A N D P R E S E N T UP O N R E Q UES T , D O C UM E N T A T IO N N E C E S S A R Y T O S UP P O R T TH IS C E R T IF IC A T E , A N D
A LL P E R S O N S T O WH O M T H E C E R T IF IC A TE WA S G IVE N O F A N Y C H A N G E S T H A T C O ULD A F F E C T TH E A C C UR A C Y O R VA LID IT Y
T H E G O O D S O R IG IN A TE D IN T H E T ER R IT O R Y O F O N E O R M O R E O F T H E P A R TIES , A N D C O M P LY WITH TH E O R IG IN R E Q UIR E M E
F O R T H O S E G O O D IN T H E N O R TH A M E R IC A N F R EE T R A D E A G R E E M EN T, A N D UN LES S S P E C IF IC A LLY E XEM P TE D IN A R T IC LE 4
T H E R E H A S B E E N N O F UR T H E R P R O D UC T IO N O R A N Y O T H E R O P ER A T IO N O UT S ID E T H E T ER R IT O R IE S O F T H E P A R T IE S ; A N D
T H IS C E R T IF IC A T E C O N S IS T S O F
P A G ES , IN C LUD IN G A LL A T T A C H M E N T S .
11. B . C O M P A N Y
11c . N A M E ( P rint o r Ty p e )
11d . TITLE
11e . D A TE ( D D / M M / Y Y )
11f .
TE LEP HO N E
N U M B ER
( V o ic e )
( Fa c s im ile )
C us t o ms F o rm 4 3 4 ( 12 17 9 3 )
NAFTA
(North American Free Trade Agreement)
Provides duty free or reduced duty treatment for goods that
originate within a NAFTA Country (US, Canada, Mexico)
Must meet all rules of origin
Suppliers NEED to provide a NAFTA Certificate of Origin
for all NAFTA eligible products.
NAFTA Certificate must accompany shipping
documentation OR blanket Certification must be on file
with GEE Customs Compliance group at time of
importation.
W All fields must be complete and accurate
YES
NO
YES
1. THE TARIFF NUMBER OF THE GOOD MUST BE DETERMINED TO AT
LEAST THE SIX DIGIT LEVEL.
NON-ORIGINATING COMPONENTS AND
2. THE TARIFF NUMBER OF THE NONMATERIALS USED IN PRODUCING THE GOODS IN A NAFTA COUNTRY
MUST BE DETERMINED
YES
YES
NONDO THE CHANGES FROM THE TARIFF CLASSIFICATION OF THE NONORIGINATING MATERIALS TO THE TARIFF CLASSIFICATION OF THE
GOODS MEET THE REQUIRED TARIFF CHANGES SPECIFIED IN THE
SPECIFIC RULE OF ORIGIN?
NO
NO
YES
THE GOODS QUALIFY PROVIDED ALL OTHER
REQUIREMENTS IN THE SPECIFIC RULES OF ORIGIN ARE
MET?