United States Mexico Canada Agreement (USMCA)

Certificate of Origin

Certifier Name & Address

Tax ID No.

Producer Name & Address

Tax ID No.

Blanket Period

From:

To:

Exporter Name & Address

Tax ID No.

Importer Name & Address

Tax ID No.

Description of Goods HS No. Origin
Criterion
Certification
Indicator
Method of
Qualification
Country
of Origin
+ Row

Authorized Signature

Name

Title

Company

Email

Date

Telephone