CBP Form 434 - North American Free Trade Agreement Certificate of Origin

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
11f. TELEPHONE NUMBERS
I CERTIFY THAT:
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;
I AGREE TO MAINTAIN AND PRESENT UPON REQUEST, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATE, AND TO INFORM, IN
WRITING, ALL PERSONS TO WHOM THE CERTIFICATE WAS GIVEN OF ANY CHANGES THAT COULD AFFECT THE ACCURACY OR VALIDITY OF
THIS CERTIFICATE;
THE GOODS ORIGINATED IN THE TERRITORY OF ONE OR MORE OF THE PARTIES, AND COMPLY WITH THE ORIGIN REQUIREMENTS
SPECIFIED FOR THOSE GOODS IN THE NORTH AMERICAN FREE TRADE AGREEMENT AND UNLESS SPECIFICALLY EXEMPTED IN ARTICLE
411 OR ANNEX 401, THERE HAS BEEN NO FURTHER PRODUCTION OR ANY OTHER OPERATION OUTSIDE THE TERRITORIES OF THE
PARTIES; AND
11.
TAX IDENTIFICATION NUMBER:
4. IMPORTER NAME, ADDRESS AND EMAIL
2. BLANKET PERIOD
TAX IDENTIFICATION NUMBER:
3. PRODUCER NAME, ADDRESS AND EMAIL
1. EXPORTER NAME, ADDRESS AND EMAIL
FROM (mm/dd/yyyy)
TO (mm/dd/yyyy)
9.
NET COST
8.
PRODUCER
5.
DESCRIPTION OF GOOD(S)
6.
HS TARIFF
CLASSIFICATION
NUMBER
7.
PREFERENCE
CRITERION
10.
COUNTRY
OF ORIGIN
11d. TITLE
11b. COMPANY11a. AUTHORIZED SIGNATURE
11c. NAME
(Voice) (Facsimile)
CBP Form 434 (11/14)
PAGES, INCLUDING ALL ATTACHMENTS.
THIS CERTIFICATE CONSISTS OF
11e. DATE (mm/dd/yyyy)
NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN
19 CFR 181.11, 181.22
TAX IDENTIFICATION NUMBER:
OMB No. 1651-0098
Exp. 10-31-2016
11g. EMAIL
Page 1/2
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CBP Form 434 - North American Free Trade Agreement Certificate of Origin PDF

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