Cbp Form 446 - Nafta Verification Of Origin Questionnaire

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OMB No. 1651-0098
DEPARTMENT OF HOMELAND SECURITY
Exp. 10-31-2016
U.S. Customs and Border Protection
NAFTA VERIFICATION OF ORIGIN QUESTIONNAIRE
19 CFR 181.72
This questionnaire is sent to you pursuant to 19 CFR 181.72, The questionnaire will be used in
determining if the
described on the NAFTA Certificate of Origin (CO) dated
and signed by
originates under the NAFTA. If necessary, additional information may be requested at a later date.
EXPORTER
PRODUCER OF GOOD
If this box is checked, you are being sent this questionnaire as the exporter
If this box is checked, you are being sent this questionnaire as the producer
of the imported good. If you relied upon a Certificate of Origin or written
of the imported good.
representation from the Producer to prepare your Certificate of Origin,
The good was exported by
provide a copy of what it was that you relied upon, and then go directly to
Section V and complete it. If you relied upon your knowledge of the good,
Complete the questionnaire.
complete the questionnaire.
EXPORTER/PRODUCER
PRODUCER OF MATERIAL
If this box is checked, you are being sent this questionnaire as the exporter
If this box is checked, you are being sent this questionnaire because
and also the producer of the imported good. Complete the questionnaire.
identified you as the producer of the
material(s) used in the production of the good described above. Complete
the questionnaire.
You have until
to return the completed and signed questionnaire to the requesting CBP office. You may fax your response. If a
reply cannot be made by this date, please contact the CBP office by mail, telephone, or fax. If additional space is needed for your response, attach additional
pages as needed. When the verification is completed, the exporter/producer will receive a written determination of the findings. The producer of a verified
material will also be notified of the results of the verification of the material. The confidential business information collected on the questionnaire may only be
disclosed to those authorities responsible for the administration and enforcement of determinations of origin, and of customs and revenue matters.
The questionnaire must be signed and dated by an individual who can certify as to the accuracy of the information provided in the questionnaire. Failure to
complete and return this questionnaire may result in the denial of preferential treatment under the NAFTA.
SECTION I
PRODUCTION PROCESS
Provide a brief description of the production process for the good/material being verified.
SECTION II
NON-ORIGINATING/UNKNOWN MATERIALS OR COMPONENTS
Provide the following information for each non-originating material or component and for each material or component whose origin is unknown, used to
produce the good being verified. If none were used, state "NONE".
Description of the material or component
HS#
HS#
Provide the six digit Harmonized System number or if the rule of origin of the good requires eight digits, supply eight.
CBP Form 446 (04/97)

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