Fillable Printable US Certificate of Origin Form
Fillable Printable US Certificate of Origin Form
US Certificate of Origin Form
US Certificate of Origin
The undersigned ______________________________________________________________________________________________
(Owner or Agent)
____________________________________________________________________________________________________________
(Name and Address of Shipper)
declares that the following mentioned goods shipped on ______________________________ on the date ____________consigned to:
____________________________________________________________________________________________________________
are the product of the United States of America.
WEIGHT IN KILOS
MARKS AND NUMBERS
NO. OF
PKGS
BOXES
OR CASES
GROSS
DESCRIPTION
Bill of Lading/Air Waybill No.:
Sworn to before me
this ______________ day of __________________ 20___ ______________________________________________________
Signature of Owner or Agent
The ____________________________________________________________________________________________________________________
a recognized Chamber of Commerce under the laws of the State of _____________________________________, has examined the manufacturer’s
invoice or shipper’s affidavit concerning the origin of the merchandise and according to the best of its knowledge and belief, finds that the products
named originated in the United States of North America.
Secretary___________________________________________
