11. I CERTIFY THAT:
1. Blanket Period: (dd/mm/yyyy) 2. Single Shipment
3. Certifier's Name and Address: 4. Exporter's Name and Address:
5. Producer's Name and Address: 6. Importer's Name and Address:
8. HS Tariff
Classification
7a. Part Number 7b. Description of Good(s)
9. Origin
Criterion
10. Country
of Origin
Updated 2021.03.31
Certification of Origin
Canada-United States-Mexico Agreement (CUSMA)
Tratado México Estados Unidos Canadá (T-MEC)
United States-Mexico-Canada Agreement (USMCA)
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 verification visit, documentation necessary to support this certification.
This Certification consists of ___________ pages, including all attachments.
Name:
From: To: Invoice Number:
Title:
Company:Authorized Signature:
Date:
(dd/mm/yyyy) Email:
Email Address:
Telephone:
Telephone:
Certifying Party: Exporter
Producer Importer
Email Address:
Telephone:
Email Address:
Telephone:
Email Address:
Telephone:
click to sign
signature
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Certification of Origin
Continuation Page(s)
Canada-United States-Mexico Agreement (CUSMA)
Tratado México Estados Unidos Canadá (T-MEC)
United States-Mexico-Canada Agreement (USMCA)
8. HS Tariff
Classification
9. Origin
Criterion
10. Country
of Origin
Year:
Page ___
7a. Part Number 7b. Description of Good(s)
Certification of Origin
Instructions
For purposes of obtaining preferential tariff treatment at the time of entry, this document must be completed legibly and in
full, and be in the possession of the Importer at the time the declaration is made. This document may be completed by the
Producer, Exporter and/or Importer.
The certification of origin should include the following data fields and information:
Field 1: BLANKET PERIOD (DD/MM/YYYY)
"FROM" is the date upon which the certification becomes applicable to the good covered by the blanket Certification (it may be prior to
the date of signing this certification). "TO" is the date upon which the blanket period expires. In no instance should that certification
exceed a 12-month period, and any information provided should be updated in the event any previously-issued certification no longer
applies. Complete this field if applicable.
Field 2: SINGLE SHIPMENT
If the certification is only applicable to a single shipment this should be indicated by typing "YES" to the right of Single Shipment and
providing the Invoice Number applicable to the single shipment. Complete this field if applicable.
Field 3: CERTIFIER'S NAME AND ADDRESS
Provide the Certifier’s name, title, address (including country), e-mail address, and telephone number. Indicate whether the Certifier is the
Exporter, or Producer, or Importer in accordance with Article 5.2 (Claims for Preferential Treatment) of the Agreement.
This is a mandatory field.
Field 4: EXPORTER'S NAME AND ADDRESS
Provide the exporter's name, address (including country), email address, and telephone number if different from the certifier.
The address of the exporter shall be the place of export of the good in a Party's territory. This address must be in the territory of a
CUSMA Party (Canada, US or Mexico). This information is not required if the producer is completing the certification of origin and does
not know the identity of the exporter. In these circumstances, state "Unknown".
Field 5: PRODUCER'S NAME AND ADDRESS
Provide the producer's name, address (including country), email address, and telephone number if different from the certifier or exporter.
The address of a producer shall be the place of production of the good in a Party's territory. This address must be in the territory of a
CUSMA Party (Canada, US or Mexico). If there are multiple producers, state "Various" or provide a list of the producers. A person that
wishes for this information to remain confidential may state "Available upon request by the importing authorities". If the producer is
unknown, state "Unknown".
Field 6: IMPORTER'S NAME AND ADDRESS
Provide, if known, the importer's name, address, email address, and telephone number. The address of the importer shall be in a Party's
territory. This address must be in the territory of a CUSMA Party (Canada, US or Mexico). If there are multiple importers, state "Various"
and provide a list of the importers upon request by the CBSA. If the importer is unknown, state "Unknown".
Field 7: PART NUMBER & DESCRIPTION OF GOODS
Provide a full description of each good subject to the certification. The description should be sufficient to relate it to the invoice
description and to the Harmonized System (HS) description of the good. The description can include part number(s) in addition to the full
description. If the certification of origin covers a single shipment of a good, indicate, if known, the invoice number related to the
exportation.
Field 8: HS CLASSIFICATION NUMBER
For each good described in the certification, identify the HS tariff classification to six digits as specified for each good in the Rules of
Origins set forth. If the good is subject to a specific rule of origin that requires eight digits, identify the HS tariff classification to an eight
digit level.
Certification of Origin
Instructions - continued
Field 9: ORIGIN CRITERION
For each good described in the certification, state which Origin Criterion (A through D) is applicable. The rules of origin are contained in
Chapter Four and Article 4.2. NOTE: In order to be entitled to preferential tariff treatment, each good must meet at least one of the
criteria below: A, B, C, or D.
(A) Wholly obtained or produced entirely in the territory of one or more of the Parties, as defined in Article 4.3; (Wholly Obtained or
Produced Goods)
(B) Produced entirely in the territory of one or more of the Parties using non-originating materials provided the good satisfies all
applicable requirements of Annex 4-B (Product-Specific Rules of Origin);
(C) Produced entirely in the territory of one or more of the Parties exclusively from originating materials; or
(D) Except for a good provided for in Chapter 61 to 63 of the Harmonized System:
(i) Produced entirely in the territory of one or more of the Parties;
(ii) one or more of the non-originating materials provided for as parts under the Harmonized System used in the production of the
good cannot satisfy the requirements set out in Annex 4-B (Product-Specific Rules of Origin) because both the good and its
materials are classified in the same subheading or same heading that is not further subdivided into subheadings or, the good was
imported into the territory of a Party in an unassembled or a disassembled form but was classified as an assembled good pursuant
to rule 2(a) of the General Rules of Interpretation of the Harmonized System; and
(iii) the regional value content of the good, determined in accordance with Article 4.5 (Regional Value Content), is not less than 60
percent if the transaction value method is used, or not less than 50 percent if the net cost method is used; and the good satisfies
all other applicable requirements of this Chapter.
Field 10: COUNTRY OF ORIGIN
Identify the country of origin for each good listed in this certification. ("MX" or "US" for all goods exported to Canada; "US" or "CA" for all
goods exported to Mexico; or "CA" or "MX" for all goods exported to the United States) as a result of which the preferential rate of duty
applies.
Field 11: CERTIFICATION
This document must be completed, signed, and dated by the Certifier. The date must be the date the Certification was completed and
signed. State the legal name, address, telephone, and e-mail address of the responsible official or authorized agent of the Certifier. The
certification can accept an electronic or digital signature, as long as it is an actual representation of the signer’s signature and not a
signature font. Example of an electronic or digital signature is a scanned image of the signer's ink signature.
The total number of pages of the certification should be provided on the main page where it states "*this Certification consists of ____
pages, including all attachments."
Continuation Pages
If additional lines are needed use the Continuation Page(s). Continuation page numbers should be inserted at the bottom of each page.
Links
CUSMA
https://www.international.gc.ca/trade-commerce/trade-agreements-accords-commerciaux/agr-acc/cusma-aceum/text-texte/toc-tdm.aspx?lang=eng
USMCA
https://ustr.gov/trade-agreements/free-trade-agreements/united-states-mexico-canada-agreement/agreement-between
T-MEC
https://www.gob.mx/t-mec/acciones-y-programas/textos-finales-del-tratado-entre-mexico-estados-unidos-y-canada-t-mec-202730?state=published