11f. TELEPHONE NUMBER JTHE INFORMATION ON THIS DOCUMENT IS TRUE AND ACCURATE AND I ASSUME THE RESPONSIBILITY FOR PROVING SUCH REPRESENTATIONS.J I UNDERSTAND THAT I AM LIABLE FOR ANY FALSE STATEMENTS OR MATERIAL OMISSIONS MADE ON ORJIN CONNECTION WITH THIS DOCUMENT; JTHE 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 11. OMB No.
1651-0098 See back of form for Paper- work Reduction Act Notice. NORTH AMERICAN FREE TRADE AGREEMENT TAX IDENTIFICATION NUMBER: 4. IMPORTER NAME AND ADDRESS 2.
BLANKET PERIOD TAX IDENTIFICATION NUMBER: 3. PRODUCER NAME AND ADDRESS TAX IDENTIFICATION NUMBER: 1. EXPORTER NAME AND ADDRESS 19 CFR 181.11, 181.22 Bill of Lading / Air Waybill No.
: Please print or type FROM TO 9. NET COST 8. PRODUCER 5.
DESCRIPTION OF GOOD(S) 6. HS TARIFF CLASSIFICATION NUMBER 7. PREFERENCE CRITERION 10.
COUNTRY OF ORIGIN 11d. TITLE 11b. COMPANY 11a.
AUTHORIZED SIGNATURE 11c. NAME (Print or Type) (Voice) (Facsimile) CBP Form 434 (04/97) PAGES, INCLUDING ALL ATTACHMENTS. THIS ... more. less.
CERTIFICATE CONSISTS OF I CERTIFY THAT: JJ I AGREE TO MAINTAIN AND PRESENT UPON REQUEST,J 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 ACCURACYJ OR VALIDITY OF THIS CERTIFICATE; 11e.<br><br> DATE (MM/DD/YYYY) CERTIFICATE OF ORIGIN U.S. DEPARTMENT OF HOMELAND SECURITYJ Bureau of Customs and Border Protection This field must be completed, signed, and dated by the exporter.J When the Certificate is complete by the producer for use by t he exporter, it must be completed, signed, and dated by the producer.J The date must be the date the Certificate was complete and signed. The good incorporated one or more non-originating materials, provided for as parts under H.S., which could not undergo a change in tariff classification because the heading provided for both the good and its parts and was not further subdivided into subheadi ngs,Jor the subheading provided for both the good and its parts and was not further subdivided.<br><br> PAPERWORK REDUCTION ACT NOTICE:: This information is needed to carry out the terms of the North American Free Trade Agreement (NAFTA). NAFTA requires that, upon request, an importer must provide CBP with proof of the explorer's written certification of the origin of the goods. The certification is essential to substantiate compliance with the rules of origin under the Agreement.J You are required to give us this information to obtain a benefit.<br><br> NORTH AMERICAN FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN INSTRUCTIONS For purposes of obtaining preferential tariff treatment, this document must be completed legibly and in full by the exporter and be in the possession of the importer at the time the declaration is made. This document may also be completed voluntarily by the producer for use by the exporter.J Please print or type: State the full legal name, address (including country) and legal tax identification number of the exporter. Legal taxation numb er is: in Canada, employer number or importer/exporter number assigned by Revenue Canada; in Mexico, federal taxpayer's registryJnumber (RFC); and in the United States, employer's identification number or Social Security Number.<br><br> FIELD 1: CompleteJ fieldJ ifJ theJ CertificateJ coversJ multipleJ shipmentsJJ ofJ identical goodsJ asJ describedJ inJ FieldJ # 5 thatJ a re imported into a NAFTA country for a specified period of up to one year (the blanket period).J "FROM" isJ the date upon which to Certificate bec omes applicable to the good covered by the blanket Certificate (it may be prior to the date of signing this Certificate).J "TO" is t he date upon which the blanket period expires.J TheJ importation of a good for which preferential treatment is claimed based on this Certificate m ust occur between these dates. FIELD 2: StateJ theJ fullJ legalJ name,J addressJ (including country)J andJ legalJ tax indetification number,J asJ definedJ in Field #1, of the producer.J If more than one producer's good is included on the Certificate, attach a list of additional producers, including the legal name, address (including country) and legal tax identification number, cross-referenced to the good described in Field #5.J If you wish this information to be confidential, it is acceptable to state "Available to CBP upon request".J If the producer and the exporter are the same, comple te field with "SAME".J If the producer is unknown, it is acceptable to state "UNKNOWN". FIELD 3: State the full legal name, address (including country) and legal tax identification number, as defined in Field #1, of the impo rter.J IfJ the importer is not known, state "UNKNOWN"; if multiple importers, state "VARIOUS".<br><br> FIELD 4: Provide a full description of each good.J The description should be sufficient to relate it to the invoice description and to t he Harmonized System (H.S.)J description ofJ theJgood. J If theJCertificateJcoversJaJsingle shipment of a good, include the invoice number as shownJon the commercial invoice.J If not known, indicate another unique reference number, such as the shipping order number. FIELD 5: FIELD 6: ForJeachJgoodJdescribedJinJField #5, stateJ whichJ criterion (A through F)J is applicable.J The rules of origin are contained i n ChapterJFour and Annex 401.J Additional rules are described in Annex 703.2 (certain agricultural goods), Annex 300-B, Appendix 6 (certainJ t extileJ goods)J andJ Annex 308.1 (certainJautomaticJ processing goods and their parts).JJ NOTE::In order to be entitle to:preferential tariff treatment, each good must meet at least one of the criteria below.<br><br> FIELD 7: Preference Criteria The good is "wholly obtained or produced entirely" in the territory of one or more of the NAFTA countries as referenced in Arti cle 415.JJ Note: The purchase of a good in the territory does not necessarily render it "wholly obtained or produced". J If the good is an agricultural good, see also criterion F and Annex 703.2.J (Reference: Article 401(a) and 415) A The good is produced entirely in the territory of one or more of the NAFTA countries and satisfies the specific rule of origin, set out in Annex 401, that applies to its tariff classification.J The rule may include a tariff classification change, regional value-cont ent requirement, or a combination thereof.J The good must also satisfy all other applicable requirements of Chapter Four.J If the good is an agricu ltural good, see also criterion F and Annex 703.2.J (Reference: Article 401(b)) B The good produced entirely in the territory of one or more of the NAFTA countries exclusively from originating materials.J Unde r this criterion, one or more of the materials may not fall within the definition of "wholly produced or obtained", as set out in arti cle 415.J All materials used in the production of the good must qualify as "originating" by meeting the rules of Article 401(a) through (d).J If the good is an agricultural good, see also criterion F and Annex 703.2.JJ Reference: Article 401(c). C D The good was imported into the territory of a NAFTA country in an unassembled or disassembled form but was classified as an assembled good, pursuant to H.S.<br><br> General Rule of Interpretation 2(a), or E F FIELD 8: FIELD 9: FIELD 10: FIELD 11: For each good described in Field #5,J identify the H.S.JtariffJclassification to six digits.J If the good is subject to a speci fic rule of origin in Annex 401 that requires eight digits, identify to eight digits, using the H.S. tariff classification of the country into whose territory the good is imported. Goods are produced in the territory of one or more of the NAFTA countries but do not meet the applicable rule of origin, set ou t in Annex 401, because certain non-originating materials do not undergo the required change in tariff classification.J The goods do nonet heless meet the regional value-content requirement specified in Article 401(d).J This criterion is limited to the following two circumstanc es: 1.<br><br> 2. NOTE: This criterion does not apply to Chapters 61 through 63 of H.S. J (Reference: Article 401(d)) Certain automatic data processing goods and their parts, specified in Annex 308.1, that do not originate in the territory are c onsidered originating upon importation into the territory of a NAFTA country from the territory of another NAFTA country when the most-favored-nation tariff of the good conforms to the rate established in Annex 308.1 and is common to all NAFTA countries.JJ (Reference: Annex 308.1) The good is an originating agricultural good under preference criterion A, B, or C above and is not subject to a quantitative r estriction in the importing NAFTA country because it is a "qualifying good" as defined in Annex 703.2, Section A or B (please specify).J A good l isted in Appendix 703.2B.7 is also exempt from quantitative restrictions and is eligible for NAFTA preferential tariff treatment if it m eets the definition of "qualifying good" in Section A of Annex 703.2.JJ NOTE 1: This criterion does not apply to goods that wholly originate in Canada or United States and are imported into either country.: NOTE 2: A tariff rate quota is not a quantitative restriction.<br><br> For each good described in Field #5, state "YES" if you are the producer of the good.J If you are not the producer of the good, state "NO" followed by (1), (2), or (3), depending on whether this certificate was based upon:J (1) your knowledge of whether the good qua lifies as an originating good; (2) your reliance on the producer's written representation (other than a Certificate of Origin) that the good qualifies as an originating good; or (3) a completed and signed Certificate for the good, voluntarily provided to the exporter by the producer. For each good described in field #5, where the good is subject to a regional value content (RVC) requirement, indicate "NC" if the RVC is calculated according to the net cost method; otherwise, indicate "NO".J If the RVC is calculated over a period of time, further identify the beginning and ending dates (DD/MM/YY) of that period.JJ (Reference: Article 402.1, 402.5). Identify the name of the country ("MX" or "US" for agricultural and textile goods exported to Canada; "US" or "CA" for all good s exported to Mexico; or "CA" or "MX" for all goods exported to the United States) to which the preferential rate of CBP duty applies, as set out in Annex 302.2, in accordance with the Marking Rules or in each party's schedule of tariff elimination.<br><br> For all other originating goods exported to Canada, indicate appropriately "MX" or "US" if the goods originate in that NAFTA co untry, within the meaning of the NAFTA Rules of Origin Regulations, and any subsequent processing in the other NAFTA country does not increas e the transaction value of the goods by more than seven percent; otherwise "JNT" for joint production.JJ (Reference: Annex 302.2) CBP Form 434 (04/97)(Back) The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to Bureau of Customs and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0098), Washington DC 20503.JJ