CERTIFICATE OF ORIGIN
Exporter
Consignee
Invoice / Reference Number
Date
Country of Export
Country of Destination
Goods and Origin
| Qty | Description | HS / Tariff Ref. | Country of Origin |
|---|---|---|---|
Certification
Certification Statement / Notes
Authorized signature / name / title
Date
General-purpose origin worksheet. A customer, chamber of commerce, free-trade agreement, customs authority or other party may require a specific certificate or certification procedure.