Cbp Form 434 - North American Free Trade Agreement Certificate Of Origin
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1
2North American Free Trade Agreement
CERTIFICATE OF ORIGIN
(Instructions on reverse)
Please Print or Type
1. E
N
A
2. B
P
(DD/MM/YYRR)
XPORTER
AME AND
DDRESS:
LANKET
ERIOD
F
ROM:
T
O:
T
I
N
AX
DENTIFICATION
UMBER:
3. P
N
A
4. I
N
A
RODUCER
AME AND
DDRESS:
MPORTER
AME AND
DDRESS:
T
I
N
T
I
N
AX
DENTIFICATION
UMBER:
AX
DENTIFICATION
UMBER:
5. D
G
6. H.S. T
7.P
8.P
9.N
C
10.COUNTRY
ESCRIPTION OF
OODS:
ARIFF
REFERENCE
RODUCER
ET
OST
OF ORIGIN
C
C
LASSIFICATION
RITERION
N
UMBER
I
CERTIFY THAT:
- T
I
I
I
HE INFORMATION ON THIS DOCUMENT IS TRUE AND ACCURATE AND
ASSUME THE RESPONSIBILITY FOR PROVING SUCH REPRESENTATIONS,
UNDERSTAND THAT
AM
LIABLE FOR ANY FALSE STATEMENTS OF MATERIAL OMISSIONS MADE ON OR IN CONNECTIONS 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;
- T
P
HE GOODS ORIGINATED IN THE TERRITORY OF ONE OR MORE OF THE
ARTIES, AND COMPLY WITH THE ORIGIN REQUIREMENTS SPECIFIED FOR THOSE GOODS IN THE
N
A
F
T
A
A
411
A
401
ORTH
MERICAN
REE
RADE
GREEMENT, AND UNLESS SPECIFICALLY EXEMPTED IN
RTICLE
OR
NNEX
, THERE HAS BEEN NO FURTHER PRODUCTION OR
P
ANY OTHER OPERATION OUTSIDE THE TERRITORIES OF THE
ARTIES; AND
__1__
- T
HIS CERTIFICATE CONSISTS OF _
_ PAGE(S), INCLUDING ALL ATTACHMENTS.
11. A
S
C
OMPANY:
UTHORIZED
IGNATURE:
N
:
T
:
AME (PRINT OR TYPE)
ITLE
D
T
F
ATE: (DD/MM/YR)
ELEPHONE:
AX:
B 232E (93/12)
CF 434
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