U.s. Certificate Of Origin For Exports To Israel Form

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U.S. CERTIFICATE OF ORIGIN
FOR EXPORTS TO ISRAEL
1. Goods consigned from exporter’s business (name, address):
Reference No.
U.S.-ISRAEL FREE TRADE AREA
CERTIFICATE OF ORIGIN
(Combined declaration and certificate)
2. Goods consigned to (consignee’s name, address)
(See notes over leaf)
3. Means of transport and route (as far as known)
4. For official use
5. Item
6. Marks and
7. Number and kind of packages, description of goods
8. Origin criterion
9 Gross Weight
10. Number and
number
number of
(see notes over
or other quantity
date of invoices
packages
leaf)
11. CERTIFICATION
12. DECLARATION BY THE EXPORTER
The ___________________________________________________
The undersigned hereby declares that the above details and
a recognized chamber of commerce, board of trade, or ___________
statements are correct; that all the goods were produced in the
___________________ under the laws of the State of ____________
United States of America and that they comply with the origin
____________________________ has examined the manufacturer’s
requirements specified from those goods in the U.S.-Israel Free
invoice or shipper’s affidavit concerning the origin of the
Trade Area Agreement for goods exported to Israel.
merchandise and, according to the best of its knowledge and
belief, finds that the products named originated in the United
States of America.
_____________________________
____________________________
Signature of Exporter
Certifying Official
Sworn to before me this _______________________
EXPORTER AS PRODUCER:
day of ____________________ 20_____
The undersigned hereby declares that he/she is the producer of the
goods listed in this invoice and that they comply with the origin
requirements specified for those goods in the U.S.-Israel Free
Trade Area Agreement for goods exported to Israel.
___________________________________________________
Signature of Notary Public
____________________________
Signature of Exporter
RESET
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