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Certificate of Origin

This document confirms and/or certifies the country of origin of products. It may be required by certain countries or by the terms of a letter of credit. Sometimes it may require local Chamber of Commerce certification. This sample form is sufficient for most countries but some countries have a specific form that that is required for proof of origin so products can qualify for preferential duty rates (typically when free trade agreements exist). The United States currently has free trade agreements with Australia, Bahrain, Chile, Israel, Jordan, Morocco, Singapore, and is a member of the North American Free Trade Agreement (NAFTA), and the Central American Free Trade Agreement (CAFTA). To obtain more information regarding certificate of origin requirements for these countries, visit .

EXAMPLE: Certificate of Origin

CERTIFICATE OF ORIGIN

|Shipper/exporter (name and address including zip code): |Booking/shipment number: |B/L or AWB number: |

| | | |

| |Export references: |

|Consignee (name and address): |Forwarding agent (name and address - references): |

| | |

|Intermediate consignee/notify party (name and address): |Point (state and country) of origin: |

| |. |

| |Domestic routing / export instructions: |

| | |

|Pre-carriage by: |Place of receipt: | |

|Exporting carrier: |Port of loading/export: |Transportation method: |

|Foreign port of unloading (vessel and air only): |Place of delivery by on-carrier: |Containerized (vessel only): |

| | |YES NO |

|Container No. / Seal No. / | | | | |

|Marks and Numbers: |Number of Packages:|Description of commodities, | | |

| | |Model/Serial number, harmonized number |Gross weight (kg): |Measurement |

| | | | | |

| | | | | |

The undersigned (Owner or Agent), does hereby declare for the above named shipper, the goods as described on the above date and consigned as indicated and are products of the United States of America. Dated at on the day of ,

. Sworn to before me this day of _______, ________.

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, finds that the products named originated in the United States of America.

Secretary

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