The information on this document is true and accurate and I assume the responsibility for
proving such representations. I understand that I am liable for any false statements or
material omissions made on or in connection with this document;
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
Commercial Invoice - Certication of Origin
(Single non-blanket)
USMCA/T-MEC/CUSMA
Combination North American Free Trade Agreement certicate of origin and invoice (Not a blanket certicate): of
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PRODUCER’S NAME AND ADDRESS (IF CERTIFIER)
VARIOUS AVAILABLE UPON REQUEST BY THE IMPORTING AUTHORITIES.
EXPORTER’S NAME AND ADDRESS (SELLER, CONSIGNOR)
IMPORTER’S NAME AND ADDRESS (BUYER, IF SOLD)
CONSIGNEE’S NAME AND ADDRESS (IF NOT SOLD OR IF DIFFERENT THAN BUYER)
INVOICE NUMBER
INVOICE DATE
PURPOSE OF SHIPMENT
CURRENCY OF VALUE
TRACKING NUMBER
SHIPPED FROM (IF DIFFERENT THAN EXPORTER)
RELATED NON-RELATED
NET WEIGHT
FREIGHT AMOUNT INCLUDED
QUANTITY UNIT PRICE TOTAL PRICE
INVOICE TOTAL
Name (Print or Type)
I certify that:
I certify that the goods described in this document qualify as originating and the information
contained in this document is true and accurate. I assume responsibility for proving such
representations and agree to maintain and present upon request or to make available during
a verication visit, documentation necessary to support this certication.
Authorized Signature:
(of Certier as indicated above)
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
COMPANY
TITLE
EMAIL
TELEPHONE
ADDRESS
COUNTRY
DATE
CERTIFIER IMPORTER EXPORTER PRODUCER
*Specify the origin criteria under which the good qualies, as set out in Chapter 4 Article 4.2 of the USMCA/T-MEC/CUSMA agreement.
United States
Canada
Mexico
HARMONIZED SYSTEM (HS)
TARIFF CLASSIFICATION
(Minimum 6-digit level)
*ORIGIN
CRITERION
USMCA/T-MEC/CUSMA goods
COUNTRY
OF ORIGIN
DESCRIPTION
OF GOODS
PART OR SKU
NUMBER
(if applicable)
CARRIER
This certication/invoice consists of ________________ pages, including attachments.
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