THE FOLLOWING AFFIDAVIT OF MANUFACTURE – BLANKET
(1) must be completed by the manufacturer of the goods
(2) must declare using the check boxes below whether drawback was or was not claimed upon export from the United States
(3) should be typewritten on the manufacturer’s letterhead
(4) should
include any model numbers, serial numbers, part numbers, or any other identifiable marks when describing
the goods
(5) must be signed by an officer of the Company: president, vice president, corporate secretary, or treasurer, or may be
signed by any employee of the corporation who holds a power of attorney.
AFFIDAVIT OF MANUFACTURE – BLANKET
I, declare that the merchandise described below:
Description Marks & Identifier(s) (model #, serial #, part #, etc.)
was produced by us in the United States at the following location:
Company Name
Street Address
City/Town State & Zip Code
I further declare that U.S. manufacturer’s drawback
was claimed
was not claimed
upon export from the United States.
**If U.S. manufacturer’s drawback was claimed, indicate the date of claim, port where claim was filed, and the amount of drawback:
I further declare that this merchandise was not manufactured or produced in the U.S. in a Customs bonded warehouse, Foreign
Trade Zone, or under HTS 9813.00.05 (Temporary Importation Bond).
This certification is in effect from: to:
Signature
Claim Date
Title
Port Where Filed
Company Name
Drawback Amount
Place and Date
(08/19)
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