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PROTECTED

B

(When Completed)

NORTH AMERICAN FREE TRADE AGREEMENT

CERTIFICATE OF ORIGIN

Restore/Restaurer

(Instructions Attached)
Please print or type
1

Exporter's Name and Address:

2

Blanket Period:

CC Company Halton Hills, ON L7G 4S4, CANADA.
1-647-289-3849

DD - MM - YY

DD - MM - YY

16/04/15

From

To

31/12/15

Tax Identification Number:
3

Producer's Name and Address:

4

MC Company Lucrecia Toris 37, 10.de Mayo,
D.F., Mexico
52 55 5207 4554

Importer's Name and Address:

AC Company 34 S Main St.Harrisonburg, VA 22801
U.S.
+1-941-383-2391

Tax Identification Number:

5

Tax Identification Number:

6
Description of Good(s)

HS tariff
Classification
Number

7

8

10

Producer

Net Cost

Country of Origin

B

NO(1)

NO

US

8211.92

Fishing Knife

9

Preference
Criterion

I certify that:

11

– 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 would 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
– this Certificate consists of

pages, including all attachments.

Authorized Signature:

Company:

Name: