Manufacturer'S Affidavit Form printable pdf download

Manufacturer'S Affidavit Form

MANUFACTURER’S AFFIDAVIT

DEFINITION: Product of the United States. A product of the United States is an article manufactured within the Customs

territory of the United States and may consist wholly of United States components or materials, of United States and foreign

components or materials, or wholly of foreign components or materials. If the article consists wholly or partially or foreign

components or materials, the manufacturing process must be such that the foreign components or materials have been

substantially transformed into a new and different article, or have been merged into a new and different article.

Part number or description:_______________________________________________

__________ 1. I certify and affirm that the above component part was manufactured by us.

__________ 2. I certify and affirm that the above component part was manufactured in the

United States by us from foreign material. Note description of

manufacturing process below.

__________ 3. Wholly of foreign origin.

__________ 4. Origin unknown.

__________ 5. Place of manufacture (location of plant):___________________________

I further certify that all parts listed above were not exported:

A) from continuous customs custody with remission, abatement, or refund of

duty;

B) with benefit of drawback; if so drawback amount ($__________________);

C) to comply with any law of the U.S. or regulation of any Federal agency

requiring exportation; or

D) after manufacture or production in the U.S. under item HTS 9813.00.05

MANUFACTURING PROCESS AS DESCRIBED IN #2:

This document must be signed by a person having actual knowledge of the facts.

Company

_________________________________________________________

Address

_________________________________________________________

Signature

_____________________________ Date ______________________

Title

_________________________ Entry no. _______________________

Manufacturer'S Affidavit Form