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. Please print or type. If more space is needed, please use additional pages.
Field 1: State the full legal name, address (including city and country), telephone number, fax number and e-mail address of the exporter.
Field 2: Complete this Field if the Certificate covers multiple shipments of identical goods as described in Field 5 that are imported into
Canada or Jordan for a specified period of up to 12 months (blanket period). "FROM" is the date upon which the Certificate becomes
applicable to the good covered by the blanket Certificate (it may be earlier than the date this Certificate is signed). "TO" is the date
upon which the blanket period expires. The importation of a good for which preferential tariff treatment is claimed based on this
Certificate must occur between these dates.
Field 3: If one producer, state the full legal name, address (including city and country), telephone number, fax number and e-mail address, of
said producer. If more than one producer is included on the Certificate, state "VARIOUS" and attach a list of all producers, including
their legal names, addresses (including city and country), telephone numbers, fax numbers and e-mail addresses, cross-referenced
to the good(s) described in Field 5. If you wish this information to be confidential, it is acceptable to state "AVAILABLE TO CUSTOMS
UPON REQUEST". If the producer and the exporter are the same, complete the field with "SAME".
Field 4: State the full legal name, address (including city and country), telephone number, fax number and e-mail address of the importer.
Field 5: Provide a full description of each good. The description should contain sufficient detail to relate it to the invoice description and to the
Harmonized System (HS) description of the good. If the Certificate covers a single shipment of a good, it should list the quantity and
unit of measurement of each good, including the series number, if possible, as well as the invoice number as shown on the
commercial invoice. If not known, indicate another unique reference number, such as the shipping order number, purchase order
number, or any other number that can be used to identify the goods.
Field 6: For each good described in Field 5, identify the HS tariff classification to six digits.
Field 7: For each good described in Field 5, state which criterion (A through D) is applicable. The rules of origin are contained in Chapter Four
(Rules of Origin) and Annex 4.1 (Specific Rules of Origin). NOTE: In order to be entitled to preferential tariff treatment, each good
must meet at least one of the criteria below.
Preference Criteria
A The good is "wholly obtained or produced entirely" in the territory of one or both of the Parties, as referred to in Article 4-1(2). NOTE:
The purchase of a good in the territory does not necessarily render it "wholly obtained or produced entirely". ( Reference: Articles 4-1
(1)(a) and 4-1(2))
B The good is produced entirely in the territory of one or both of the Parties and satisfies the product specific rule of origin, set out in
Annex 4.1 that applies to its tariff classification. The rule may include a change in tariff classification or a change in tariff classification
plus a value test. The good must also satisfy all other applicable requirements of Chapter Four. ( Reference: Article 4-1(1)(b))
C The good is produced entirely in the territory of one or both of the Parties exclusively from originating materials. Under this criterion,
one or more of the materials may not fall within the definition of "wholly obtained or produced entirely", as set out in Article 4-1(2). All
materials used in the production of the good must qualify as “originating" by meeting the rules of origin of Article 4-1(1)(a) through (d).
(Reference: Article 4-1(1)(c))
D The good is produced entirely in the territory of one or both of the Parties but does not meet the applicable rule of origin, set out in
Annex 4.1 because certain non-originating materials do not undergo the required change in tariff classification. The good does
nonetheless satisfy the value test specified in Article 4-1(1)(d)(ii). This criterion is limited to the following circumstance: the good
incorporates one or more non-originating materials which cannot undergo a change in tariff classification because both the good and
the non-originating materials are classified in the same subheading, or heading that is not further subdivided into subheadings.
NOTE: This criterion does not apply to goods of Chapters 39 or 50 through 63 of the HS. (Reference: Article 4-1(1)(d))
Field 8: For each good described in Field 5, state "YES" if you are the producer of the good. 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: (1) your knowledge of whether the good
qualifies 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.
Field 9: Identify the name of the country of origin ("JO" for all originating goods exported to Canada; "CA" for all originating goods exported to
Jordan).
Field 10: This Field may be used when there is some observation relating to this Certificate, such as, when the good or goods described in
Field 5 have been subject to an advance ruling or a ruling on the classification or value of materials. Indicate the issuing authority, the
reference number, and the date of issuance.
Field 11: This Field must be completed, signed and dated by the exporter. When the Certificate is completed by the producer for use by the
exporter, it must be completed, signed and dated by the producer. The date must be the date the Certificate was completed and
signed.
