Certificate Of Origin
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1Certificate of Origin
_______________________________________________________________________
The undersigned
_______________________________________________________________________
(Owner or Agent)
_________________________________________________________________________________
for
___________________________________________________________________________________
(Name and Address of Shipper)
declares the following listed goods shipped on _____________________________________________
(Name of Carrier)
on _____________________________________________ consigned to __________________________
(Shipment Date)
(Recipient’s Name)
______________________________________________________________________________________
(Recipient’s Name and Address)
are the products of the United States of America.
Marks &
No. of Packages,
Weight in Kilos
Full Description of Item
Numbers
Boxes or Cases
Gross
Net
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
State of _________________________________
County of __________________________________
Sworn to me __________________________________________________________________________
this ____________ day of _________, 20_____ ______________________________________________
(Signature of Owner or Agent)
______________________________________________________________________________________
The ________________________________________, a recognized Chamber of Commerce Under
the laws of the State of ___________________________________, has examined the manufacturer’s
invoice or shipper’s affidavit concerning the origin of the merchandise and, according to the best
of its knowledge and belief, finds that the products named originated in the United States of North
America.
Secretary _________________________________________________
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Parent category: Business