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 by the Exporter and be in the possession of the Importer at the time the declaration is made.
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) CERTIFICATION OF ORIGIN
Blanket Period: (MM/DD/YYYY)
From:
01/01/2021
To:
12/31/2021
Certifier's Name and Address:
Single Shipment: Invoice Number:
Exporter's Name and Address:
Telephone: E-Mail Address: Tax Identification Number: Producer's Name and Address:
Telephone: E-Mail Address: Tax Identification Number: Importer's Name and Address:
Telephone: E-Mail Address: Tax Identification Number:
Part Number
Description of Good(s)
Tariff Number
Telephone: E-Mail Address: Tax Identification Number:
Origin Criterion
Certification Indicator
Qualification Method
Country of Origin
Accumulation Value (USD)
Labor Value Content
Requirement
See Attached
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 certification.
* The goods originated or are considered to have originated in the territory of one or more of the parties, and comply with the origin requirements specified for those goods in the United States-Mexico-Canada Free Trade Agreement; there has been no no further production or any other operation outside the territories of the parties, other than unloading, reloading, or any other operation necessary to preserve the goods in good condition or to transport the goods to the territories of the parties; the goods remained under the control of the customs authorities while in the territory of a non-party; and
* I also agree to notify any party provided with this certificate of any changes that might adversely impact a certification previously given.
*This certification consists of
pages, including all attachments.
Authorized Signature:
Company:
Name:
Title:
Date: (MM/DD/YYYY)
Email:
Telephone:
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 2 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 3 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 4 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 5 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 6 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 7 of 16
Part Number
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Supplier Product Code Description of Good(s)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Country of Origin
Printed: 3/24/21 - (LICG12/121213)
Page 8 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 9 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 10 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 11 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 12 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 13 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 14 of 16
NITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA) 2021 CERTIFICATION OF ORIGIN CONTINUATION PAGE(S)
Tariff Number
Origin Criterion
Certification Indicator Qualification Method
Year: 2021 Country of Origin Accumulation Value (USDL)abor Value Content Requirement
Printed: 3/24/21 - (LICG12/121213)
Page 15 of 16
UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA)
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 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 in preparing its own Certification of Origin. In preparing its own Certification of Origin, any party completing a USMCA Certification of Origin must retain all documentation in support of that declaration for a period of no less than seven (7) years from the date of execution and agree to produce such documentation within 14 days of request. Please print or type:
The certification of origin should include the following data fields and information:
BLANKET PERIOD (MM/DD/YYYY) -Blanket Period: "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 aSpIpNlGiesL.ECoSmHpIPleMteEthNisTf:ieIlfdtihfeacpeprltiicfaicbaleti.on 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.
CERTIFIER'S NAME AND ADDRESS - Provide the Certifier's name, title, address (including country), e-mail address, telephone number and the legal taxation number. Indicate whether the Certifier is the Exporter, or Producer, or Importer in accordance with Article 5.2 (Claims for Preferential Treatment) of the USMCA text. This is a mandatory field. https://ustr.gov/sites/default/files/files/agreements/FTA/USMCA/Text/05_Origin_Procedures.pdf Legal taxation number is: in Canada employer number or importer/exporter number assigned by Revenue Canada; in Mexico federal taxpayer's registry number (RFC); and in the United States, employer's identification number or Social Security number.
EXPORTER'S NAME AND ADDRESS -Provide the Exporter's name, address (including country), e-mail address, telephone number and the legal taxation number if different from the Certifier or "N/A" or "Various" or "Same as Certifier". This information is not required if the Producer is completing the certification 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 Party's territory.
PRODUCER'S NAME AND ADDRESS -Provide the Producer's name, address (including country), e-mail address, telephone number and the legal taxation number, if different from the Certifier or Exporter or, if there are multiple Producers, state "Available upon request by the importing authorities" or "Same as Certifier", "Various", or provide a list of producers. A person that wishes for 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 Party's territory. IMPORTER'S NAME AND ADDRESS - State the full legal name, address (including country), e-mail address (if any), telephone number and legal tax identification number, as defined for the Certifier or "Same as Certifier". The address of the Importer shall be in a Party's territory. If there are multiple importers, state "Various". If there is no Importer, state "N/A". PART NUMBER AND DESCRIPTION OF GOODS - Provide the part number and description of each good subject to the certification. The description should be sufficiently detailed such that it can be related to the invoice description and to the Tariff Number/ Harmonized System (H.S.) description of the good. The description can include part number references but should also provide a description of the item sufficient to identify and associate it with the Tariff Number. HS TARIFF NUMBER - For each good certified, identify the H.S. tariff classification to six digits as necessary 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 tariff number to an eight digit level.
ORIGIN CRITERION - For each good described in the certification, state which criterion (A through D) is applicable. The rules of origin are contained in Chapter Four and Article 4.2. 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 Note: If the item does not meet the applicable Rule of Origin for USMCA (not eligible good), please leave this field blank. h(att)pWs:/h/uosltlry.goobvt/asiinteesd/doerfparuoltd/uficleesd/feinletisr/ealgyreinemtheenttse/rFriTtoAry/UoSfMonCeAo/rTmexotr/e04o-fRtuhleePs-aorft-ieOsr,iagsind.pefdifned in Article 4.3; (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; CERTIFICATION INDICATOR: (this can be a combination but must include that the certifier is either the producer or has as a statement from the producer): A, B, C or D A Certifier has a certification or statement from the Producer B Certifier is the Importer C Certifier is the Exporter D Certifier is the Producer
QUALIFICATION METHOD - For each good certified, where the good is subject to a regional value content (RVC) requirement, indicate "NC" if the RVC is calculated according to the net cost method; where transaction value was used indicate "TV"; where tariff shift alone applied, use "TS". If the Rule of Origin is a combined tariff shift/RVC rule, indicate "NC" where net cost was used, or indicate "TV" where transaction value was used. If the good is produced entirely in the territory of one or more of the USMCA countries exclusively from originating materials, used "NO" Note: If the item does not meet the applicable Rule of Origin for USMCA (not eligible good), please leave this field blank. COUNTRY OF ORIGIN - Identify the name of the country of production for each good listed in this certification.("CA" for Canada, "MX" for Mexico, and "US" for the United States) as a result of which the preferential rate of duty applies. If the country of production is other than "US", "CA" or "MX" (not eligible good) please provide the 2-digit ISO country code for the country of production.
ACCUMULATION VALUE - Where a good undergoes production within the USMCA Territory but that good does not meet the applicable Rule of Origin, identify that portion of the good's value which qualifies as originating consistent with Article 4.11 (Accumulation) of the USMCA text. Report the value in United States Dollar (USD) currency. https://ustr.gov/sites/default/files/files/agreements/FTA/USMCA/Text/04-Rules-of-Origin.pdf LABOR VALUE CONTENT REQUIREMENT - Automotive Industry specific only. For each Part Number provided on the USMCA Certification where the Certification Indicator is marked as "D", indicating you are the "Producer" of the part or commodity, indicate "Yes" if the part or component is produced in a plant or facility that is located within North America with a production wage rate that is at least $16/hour USD, $20.88/hour CAD or $294.22/hour MXN. As provided in Section 4-B.7 of the USMCA CUSMA/T-MEC text, the production wage rate is the average hourly base wage rate, not including benefits, of employees directly involved in the production of the part or component, and does not include salaries of management, R&D, engineering, or other workers who are not involved in the direct production of the parts or in the operation of production lines. Otherwise, indicate "No". Any supplier that qualifies an item as a High Labor Value Item through establishment of the production wage rate based on an identified averaging method is obligated to monitor that qualification to ensure the average rate remains at least $16/hour USD, $20.88/hour CAD or $294.22/hour MXN and to immediately notify any party provided a qualifying certification
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 where on the main page 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. Complete legal text of the USMCA agreement and Rules of Origin can be found here : https://ustr.gov/trade-agreements/free-trade-agreements/united-states-mexico-canada-agreement/agreement-between
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