Cbp Form 434 - North American Free Trade Agreement Certificate Of Origin
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1NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN
Please print or type
1
2
Exporter's Name and Address
Blanket Period
UPS
DD
MM
YY
From
DD
MM
YY
To
Tax Identification Number >
3
4
Producer's Name and Address
Importer's Name and Address
Tax Identification Number >
Tax Identification Number >
6
7
8
9
10
HS Tariff
5
Description of Good(s)
Classification
Preference
Producer
Net Cost
Country
Number
Criterion
Of Origin
11
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 person to whom
the Certificate was given of any changes that would 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
-- this Certificate consists of
pages, including all attachments
11a.
11b.
Authorized Signature
Company
11c.
11d.
Name
Title
11f.
11e.
Telephone
Date
DD
MM
YY
Voice
Fax
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