Fillable Printable North American Free Trade Agreement Certificate of Origin

North American Free Trade Agreement Certificate of Origin

11f.

TELEPHONE

NUMBER

I CERTIFY THAT:

• THE INFORMATION ON THIS DOCUMENT IS TRUE AND ACCURATE AND I ASSUME THE RESPONSIBILITY FOR PROVING SUCH

REPRESENTATIONS. I UNDERSTAND THAT I AM LIABLE FOR ANY FALSE STATEMENTS OR MATERIAL OMISSIONS MADE ON OR IN

CONNECTION WITH THIS DOCUMENT;

• I AGREE TO MAINTAIN AND PRESENT UPON REQUEST, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATE, AND TO INFORM, IN

WRITING, ALL PERSONS TO WHOM THE CERTIFICATE WAS GIVEN OF ANY CHANGES THAT COULD AFFECT THE ACCURACY OR VALIDITY OF

THIS CERTIFICATE;

• THE GOODS ORIGINATED IN THE TERRITORY OF ONE OR MORE OF THE PARTIES, AND COMPLY WITH THE ORIGIN REQUIREMENTS SPECIFIED

FOR THOSE GOODS IN THE NORTH AMERICAN FREE TRADE AGREEMENT AND UNLESS SPECIFICALLY EXEMPTED IN ARTICLE 411 OR ANNEX

401, THERE HAS BEEN NO FURTHER PRODUCTION OR ANY OTHER OPERATION OUTSIDE THE TERRITORIES OF THE PARTIES; AND

11.

TAX IDENTIFICATION NUMBER:

4. IMPORTER NAME AND ADDRESS

2. BLANKET PERIOD

TAX IDENTIFICATION NUMBER:

3. PRODUCER NAME AND ADDRESS

1. EXPORTER NAME AND ADDRESS

FROM

NET COST

PRODUCER

DESCRIPTION OF GOOD(S)

HS TARIFF

CLASSIFICATION

NUMBER

PREFERENCE

CRITERION

10.

COUNTRY

OF ORIGIN

11d. TITLE

11b. COMPANY11a. AUTHORIZED SIGNATURE

11c. NAME (Print or Type)

(Voice)

(Facsimile)

CBP Form 434 (04/97)

PAGES, INCLUDING ALL ATTACHMENTS.

• THIS CERTIFICATE CONSISTS OF

11e. DATE (MM/DD/YYYY)

NORTH AMERICAN FREE TRADE AGREEMENT

CERTIFICATE OF ORIGIN

19 CFR 181.11, 181.22

U.S. Customs and Border Protection

DEPARTMENT OF HOMELAND SECURITY

TAX IDENTIFICATION NUMBER:

OMB No. 1651-0098

Exp. 03-31-2012

See back of form for Paper-

work Reduction Act Notice.

Please print or type

A The good is "wholly obtained or produced entirely" in the territory of one or more of the NAFTA countries as referenced in Article 415. Note: The

purchase of a good in the territory does not necessarily render it "wholly obtained or produced". If the good is an agricultural good, see

also criterion F and Annex 703.2. (Reference: Article 401(a) and 415)

B The good is produced entirely in the territory of one or more of the NAFTA countries and satisfies the specific rule of origin, set out in Annex 401,

that applies to its tariff classification. The rule may include a tariff classification change, regional value-content requirement, or a combination

thereof. The good must also satisfy all other applicable requirements of Chapter Four. If the good is an agricultural good, see also criterion F and

Annex 703.2. (Reference: Article 401(b))

C The good is produced entirely in the territory of one or more of the NAFTA countries exclusively from originating materials. Under this criterion, one

or more of the materials may not fall within the definition of "wholly produced or obtained", as set out in article 415. All materials used in the

production of the good must qualify as "originating" by meeting the rules of Article 401(a) through (d). If the good is an agricultural good, see also

criterion F and Annex 703.2. Reference: Article 401(c).

D Goods are produced in the territory of one or more of the NAFTA countries but do not meet the applicable rule of origin, set out in Annex 401,

because certain non-originating materials do not undergo the required change in tariff classification. The goods do nonetheless meet the regional

value-content requirement specified in Article 401(d). This criterion is limited to the following two circumstances:

1. The good was imported into the territory of a NAFTA country in an unassembled or disassembled form but was classified as an assembled

good, pursuant to H.S. General Rule of Interpretation 2(a), or

2. The good incorporated one or more non-originating materials, provided for as parts under the H.S., which could not undergo a change in tariff

classification because the heading provided for both the good and its parts and was not further subdivided into subheadings, or the

subheading provided for both the good and its parts and was not further subdivided.

NOTE: This criterion does not apply to Chapters 61 through 63 of H.S. (Reference: Article 401(d))

E Certain automatic data processing goods and their parts, specified in Annex 308.1, that do not originate in the territory are considered originating

upon importation into the territory of a NAFTA country from the territory of another NAFTA country when the most-favored-nation tariff rate of the

good conforms to the rate established in Annex 308.1 and is common to all NAFTA countries. (Reference: Annex 308.1)

F The good is an originating agricultural good under preference criterion A, B, or C above and is not subject to a quantitative restriction in the

importing NAFTA country because it is a "qualifying good" as defined in Annex 703.2, Section A or B (please specify). A good listed in Appendix

703.2B.7 is also exempt from quantitative restrictions and is eligible for NAFTA preferential tariff treatment if it meets the definition of "qualifying

good" in Section A of Annex 703.2. NOTE 1: This criterion does not apply to goods that wholly originate in Canada or the United States

and are imported into either country. NOTE 2: A tariff rate quota is not a quantitative restriction.

PAPERWORK REDUCTION ACT NOTICE: This information is needed to carry

out the terms of the North American Free Trade Agreement (NAFTA). NAFTA

requires that, upon request, an importer must provide CBP with proof of the

exporters written certification of the origin of the goods. The certification is

essential to substantiate compliance with the rules of origin under the

Agreement. You are required to give us this information to obtain a benefit.

NORTH AMERICAN FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN INSTRUCTIONS

For purposes of obtaining preferential tariff treatment, this document must be completed legibly and in full by the exporter and be

in the possession of the importer at the time the declaration is made. This document may also be completed voluntarily by the

producer for use by the exporter. Please print or type:

FIELD 1: State the full legal name, address (including country) and legal tax identification number of the exporter. Legal taxation number is: in Canada,

employer number or importer/exporter number assigned by Revenue Canada; in Mexico, federal taxpayer's registry number (RFC); and in the

United States, employer's identification number or Social Security Number.

FIELD 2: Complete field if the Certificate covers multiple shipments of identical goods as described in Field #5 that are imported into a NAFTA country for a

specified period of up to one year (the blanket period). "FROM" is the date upon which Certificate becomes applicable to the good covered by the

blanket Certificate (it may be prior to the date of signing this Certificate). "TO" is the date upon which the blanket period expires. The importation

of a good for which preferential treatment is claimed based on this Certificate must occur between these dates.

FIELD 3: State the full legal name, address (including country) and legal tax identification number, as defined in Field #1, of the producer. If more than one

producer's good is included on the Certificate, attach a list of additional producers, including the legal name, address (including country) and legal

tax identification number, cross-referenced to the good described in Field #5. If you wish this information to be confidential, it is acceptable to state

"Available to CBP upon request". If the producer and the exporter are the same, complete field with "SAME". If the producer is unknown, it is

acceptable to state "UNKNOWN".

FIELD 4: State the full legal name, address (including country) and legal tax identification number, as defined in Field #1, of the importer. If the importer is

not known, state "UNKNOWN"; if multiple importers, state "VARIOUS".

FIELD 5: Provide a full description of each good. The description should be sufficient to relate it to the invoice description and to the Harmonized System

(H.S.) description of the good. If the Certificate covers a single shipment of a good, include the invoice number as shown on the commercial

invoice. If not known, indicate another unique reference number, such as the shipping order number.

FIELD 6: For each good described in Field #5, identify the H.S. tariff classification to six digits. If the good is subject to a specific rule of origin in Annex

401 that requires eight digits, identify to eight digits, using the H.S. tariff classification of the country into whose territory the good is imported.

FIELD 7: For each good described in Field #5, state which criterion (A through F) is applicable. The rules of origin are contained in Chapter Four and

Annex 401. Additional rules are described in Annex 703.2 (certain agricultural goods), Annex 300-B, Appendix 6 (certain textile goods) and Annex

308.1 (certain automatic data processing goods and their parts). NOTE: In order to be entitled to preferential tariff treatment, each good

must meet at least one of the criteria below.

Preference Criteria

FIELD 8: For each good described in Field #5, state "YES" if you are the producer of the good. If you are not the producer of the good, state "NO" followed

by (1), (2), or (3), depending on whether this certificate was based upon: (1) your knowledge of whether the good qualifies as an originating good;

(2) your reliance on the producer's written representation (other than a Certificate of Origin) that the good qualifies as an originating good; or (3) a

completed and signed Certificate for the good, voluntarily provided to the exporter by the producer.

FIELD 9: For each good described in field #5, where the good is subject to a regional value content (RVC) requirement, indicate "NC" if the RVC is

calculated according to the net cost method; otherwise, indicate "NO". If the RVC is calculated over a period of time, further identify the beginning

and ending dates (MM/DD/YYYY) of that period. (Reference: Article 402.1, 402.5).

FIELD 10: Identify the name of the country ("MX" or "US" for agricultural and textile goods exported to Canada; "US" or "CA" for all goods exported to Mexico;

or "CA" or "MX" for all goods exported to the United States) to which the preferential rate of CBP duty applies, as set out in Annex 302.2, in

accordance with the Marking Rules or in each party's schedule of tariff elimination.

For all other originating goods exported to Canada, indicate appropriately "MX" or "US" if the goods originate in that NAFTA country, within the

meaning of the NAFTA Rules of Origin Regulations, and any subsequent processing in the other NAFTA country does not increase the transaction

value of the goods by more than seven percent; otherwise indicate "JNT" for joint production. (Reference: Annex 302.2)

FIELD 11: This field must be completed, signed, and dated by the exporter. When the Certificate is completed by the producer for use by the exporter, it must

be completed, signed, and dated by the producer. The date must be the date the Certificate was completed and signed.

CBP Form 434 (04/97)(Back)

The estimated average burden associated with this collection of information is

15 minutes per respondent or recordkeeper depending on individual

circumstances. Comments concerning the accuracy of this burden estimate and

suggestions for reducing this burden should be directed to U.S. Customs and

Border Protection, Information Services Branch, Washington, DC 20229, and to

the Office of Management and Budget, Paperwork Reduction Project

(1651-0098), Washington DC 20503.