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 REF. #
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
Commercial Invoice - Certification of Origin
(Single non-blanket)
USMCA/T-MEC/CUSMA
Combination North American Free Trade Agreement certificate of origin and invoice (Not a blanket certificate): 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)
RELATED TO BUYER: YES NO
IMPORTER’S NAME AND ADDRESS (BUYER, IF SOLD) RELATED TO EXPORTER: YES NO
CONSIGNEE’S NAME AND ADDRESS SAME AS IMPORTER/BUYER
INVOICE NUMBER
INVOICE DATE
PURPOSE OF SHIPMENT
CURRENCY OF VALUE U.S. CAD OTHER _________________________
TRACKING NUMBER
SHIPPED FROM GENERAL SHIPMENT NOTES
(IF DIFFERENT THAN EXPORTER)
SHIPPING WEIGHT
FREIGHT AMOUNT INCLUDED FREIGHT TO BORDER
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 verification visit, documentation necessary to support this certification.
Authorized Signature:
(of Certifier as indicated above)
COMPANY
TITLE (
REQUIRED)
EMAIL
TELEPHONE
ADDRESS
COUNTRY
DATE
CERTIFIER IMPORTER EXPORTER PRODUCER
*For USMCA/T-MEC/CUSMA goods only. See Instructions
CARRIER
This certification/invoice consists of ________________ pages, including attachments.
DUTIES/FEES
EXPORTER EXPORTER IMPORTER
CHARGED TO: (INCLUDED IN VALUE) (NOT INCLUDED)
NUMBER OF PACKAGES / KIND
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
TELEPHONE
NAME
COUNTRY REF. #
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
TELEPHONE
NAME
COUNTRY
ADDRESS
EMAIL
TAX ID NUMBER
(Business Number)
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FedEx Express
®
air shipments: Use AWB to indicate.
QUANTITY UNIT PRICE TOTAL PRICE
HARMONIZED SYSTEM (HS)
TARIFF CLASSIFICATION
(Minimum 6-digit level)
*ORIGIN
CRITERION
See Instructions
COUNTRY
OF ORIGIN
DESCRIPTION
OF GOODS
PART OR SKU
NUMBER
(if applicable)
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Commercial Invoice - Certification of Origin (Single non-blanket) Page 1 of 3
FREIGHT AMOUNT INCLUDED FREIGHT TO BORDER
Commercial Invoice - Certification of Origin (Single non-blanket) Page 2 of 3
Commercial Invoice - Certification of Origin (Single non-blanket)
USMCA/T-MEC/CUSMA
1.
Completion Instructions
For purposes of obtaining preferential tariff treatment, this document must be completed, legible and in the possession of the importer
at the time of declaration. This document may be completed by the importer, exporter or producer.
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DESCRIPTION
Provide a full description of the good (what is it, how used),
sufficient to relate it to the Harmonized Tariff Schedule description.
HARMONIZED TARIFF CLASSIFICATION
Provide the HS tariff classification of the good at the 6-digit level.
ORIGIN CRITERION
Specify the Origin Criterion under which the good qualifies, as set
out in Chapter 4, Article 4.2 of the USMCA/T-MEC/CUSMA
agreement (Originating Goods).
Criterion A:
the territory of one or more of the USMCA/T-MEC/CUSMA
countries, as defined in Article 4.3 of the Agreement;
Criterion B: The good is produced entirely in the territory of one
or more of the USMCA/T-MEC/CUSMA countries using non-
originating materials, provided the good satisfies all applicable
requirements of product-specific rules of origin;
Criterion C: The good is produced entirely in the territory of one
or more of the USMCA/T-MEC/CUSMA countries exclusively from
originating materials; or
Criterion D: The good is produced entirely in the territory of one
or more of the USMCA/T-MEC/CUSMA countries. It is classified with
its materials, or satisfies the “unassembled goods” requirement,
and meets a regional value content threshold of not less than 60%
if the transaction value method is used, or not less than 50% if the
net cost method is used (not including RVC for autos); except for
goods in Chapter 61-63 of the HTS.
Products provided for under the tariff provisions set out in
Chapter 2 Tabl
e 2.10.1, Table 2.10.2, and Table 2.10.3
FOR U.S. IMPORTS ONLY – “Criterion E”
FOR CANADA IMPORTS ONLY – “Schedule 2 of the CUSMA
Rules of Origin Regulations
Click the links below to view the full text of the Rules of Origin for
the Importing Country: United States Mexico Canada
COUNTRY OF ORIGIN
Provide the country of origin of the goods (United States, Mexico,
Canada).
QUANTITY
Provide the quantity of the product(s) shipped (pcs, kg, dozen)
UNIT PRICE
Provide the Unit Price measurement for the quantity of goods
($1.00/pc/kg/dz)
TOTAL PRICE
Provide the total extended val
ue for the goods.
(quantity x unit price = total)
CERTIFICATION STATEMENT COMPLETION
MANDATORY - Provide all the information requested in this section,
including number of pages and Certifier’s signature and title in
order to be valid.
CERTIFIER
Importer, Exporter or Producer Certification of Origin: indicate whether
the certifier is the exporter, producer or importer in
accordance with Chapter 5, Article 5.2 (Claims for Preferential Tariff
Treatment) of the agreement.
DUTIES/FEES CHARGED TO:
FedEx Express Air shipments: Use AWB to indicate. All Other
Modes of Transport: Indicate which party is responsible for customs
clearance charges.
EXPORTER’S DETAILS
Provide the exporters name, address (including country), email
address and telephone number, if different than the certifier.
This information is not required if the producer is completing the
Certificatation of Origin and does not know the identity of the
exporter. The
address of the exporter shall be the place of export of
the good in a Partys territory.
PRODUCERS DETAILS
Provide the producer’s name, address (including country), email
address and telephone number, if different than the certifier or
exporter, or if there are multiple producers, state “Various” or
provide a list of producers. A person that wants this information to
remain confidential may state “Available upon request by the
importing authorities . The address of a producer shall be the place
of production of the good in a Partys territory.
IMPORTERS DETAILS
Provide the importers name, address, email address and
telephone number (if known). The address of the importer shall
be in a Party’s territory.
CONSIGEE’S DETAILS
Provide the consignee
s name, address, (including country),
email address and telephone number, if different than the Importer.
SHIPPED FROM/GENERAL NOTES
Provide the Shipping location name, address, (including country),
email address and telephone number, if different than the Exporter.
If there is no Shipped from address, you can input the Customs
Broker name, or other information in this area.
INVOICE NUMBER
Provide the invoice number, invoice date, purpose of
shipment (sold/not sold) and currency of value in this section.
TRACKING NUMBER
Input the tracking number if known
NUMBER/KIND OF PACKAGES
Input the total number of packages and type
(carton/drum/case, etc).
SHIPPING WEIGHT
Input
the total shipment
weight
FREIGHT AMOUNT INCLUDED
Input the freight charges included in the value, if applicable.
FREIGHT TO BORDER
For Border truck shipments, include the amount of freight to Border,
if known.
PART/SKU NUMBER
Input the part/sku number of your product, if applicable
The good is wholly obtained or produced entirely in
FOR MEXICO IMPORTS ONLY – Annex II of the Uniform
Regulations regarding USMCA Rules of Origin”
Commercial Invoice - Certification of Origin
(Single non-blanket)
USMCA/T-MEC/CUSMA
ADDITIONAL SHIPMENT NOTES:
Commercial Invoice - Certification of Origin (Single non-blanket) Page 3 of 3
CONTINUATION CHART
Please list additional goods here.
QUANTITY UNIT PRICE TOTAL PRICE
HARMONIZED SYSTEM (HS)
TARIFF CLASSIFICATION
(Minimum 6-digit level)
*ORIGIN
CRITERION
See Instructions
COUNTRY
OF ORIGIN
DESCRIPTION
OF GOODS
PART OR SKU
NUMBER
(if applicable)
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