A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.
Protected B (when completed)
- 1. Exporter's name and address:
- 2. Blanket period:
- From: 2013-03-15
- To: 2013-03-15
- 3. Producer's name and address:
- 4. Importer's name and address:
- 5. Description of Good(s)
- 6. HS Tariff Classification #
- 7. Preference Criterion
- 8. Producer
- 9. Observations:
- I certify that:
- The information in 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, every person to whom the Certificate was given of any changes that would affect the accuracy or validity of this Certificate.
- The goods originate in the territory of one or both Parties, and comply with the origin requirements specified for those goods in the Free Trade Agreement between Canada and the Republic of Panama.
- This Certificate consists of (number) pages, including all attachments.
- 10. Authorized signature:
- Date: 2013-03-15
Instructions for Completing the Certificate of Origin
For purposes of obtaining preferential tariff treatment, this document must be legible and completed 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. Please print or type. If more space is needed, please use additional pages.
Field 1: State the full legal name, address (including city and country), telephone number, fax number and e-mail address of the exporter.
Field 2: Complete this Field if the Certificate covers multiple shipments of identical goods as described in Field 5 that are imported into Canada or Panama for a specified period of up to 12 months (blanket period). "FROM" is the date upon which the Certificate becomes applicable to the good covered by the blanket Certificate (it may be a date that precedes the signing of this Certificate). "TO" is the date on which the blanket period expires. The importation of a good for which preferential tariff treatment is claimed based on this Certificate must occur between these dates.
Field 3: If a single producer, state the full legal name, address (including city and country), telephone number, fax number and e-mail address of said producer. If more than one producer is included on the Certificate, state "VARIOUS" and attach a list of all producers, including their legal names, addresses (including city and country), telephone numbers, fax numbers and e-mail addresses cross-referenced to the good(s) described in Field 5. If you prefer that this information remain confidential, please state "AVAILABLE TO CUSTOMS UPON REQUEST".
Field 4: State the full legal name, address (including city and country), telephone number, fax number and e-mail address of the importer.
Field 5: Provide a full description of each good. The description should contain sufficient detail to relate it to the invoice description and to the Harmonized System (HS) description of the good. If the Certificate covers a single shipment of a good, it should list the quantity and unit of measurement of each good, including the series number, if possible, as well as the invoice number as it appears on the commercial invoice. If the invoice number is not known, provide another unique reference number, such as the shipping order number, purchase order number, or any other number that can be used to identify the goods.
Field 6: For each good described in Field 5, identify the HS tariff classification to six digits.
Field 7: For each good described in Field 5, state which criterion (a) through (d) is applicable. The rules of origin are contained in Chapter Three (Rules of Origin) and Annex 3.02 (Product Specific Rules of Origin).
NOTE: In order to be entitled to preferential tariff treatment, each good must meet at least one of the criteria set out below:
- The good is "wholly obtained or produced entirely in the territory of one or both of the Parties" as defined in Article 3.01.
NOTE: The purchase of a good in the territory does not necessarily render it "wholly obtained or produced entirely" (Reference: Articles 3.01 and 3.02(a)).
- The good is produced entirely in the territory of one or both of the Parties and satisfies the specific rule of origin set out in Annex 3.02 that applies to its tariff classification. The rule may include a tariff classification change or a tariff classification change plus value test. The good must also satisfy all other applicable requirements of Chapter Three (Rules of Origin) (Reference: Article 3.02(b)).
- The good is produced entirely in the territory of one or both of the Parties exclusively from originating materials. Under this criterion, one or more of the materials may not fall within the definition of "good wholly obtained or produced entirely in the territory of one or both of the Parties" set out in Article 3.01. All materials used in the production of the good must qualify as "originating" by meeting the rules of origin contained in Chapter Three (Rules of Origin).
- The good is produced entirely in the territory of one or both of the Parties but does not meet the applicable rule of origin set out in Annex 3.02 because certain non-originating materials do not undergo the required change in tariff classification. The good nonetheless satisfies the value test set out in Article 3.02(d)(iii). This criterion is limited to the following circumstance: the good incorporates one or more non-originating materials which could not undergo a change in tariff classification because both the good and the non-originating materials are classified in the same subheading or heading that is not further subdivided into subheadings.
NOTE: This criterion does not apply to a good listed under headings 39.01 through 39.14 or under Chapters 50 through 63 of the HS (Reference: Article 3.02(d)).
Field 8: For each good described in Field 5, state "YES" if you are the producer of the good. If you are not the producer of the good, state "NO" followed by (1), (2) or (3), depending on whether this Certificate was based upon: (1) your knowledge of whether the good qualifies as an originating good; (2) your reliance on the producer's written representation (other than a Certificate of Origin) that the good qualifies as an originating good; or (3) a completed and signed Certificate for the good, voluntarily provided to the exporter by the producer.
Field 9: This Field may be used when there is an observation relating to this Certificate, such as when the good or goods described in Field 5 have been subject to an advance ruling or a ruling on the classification or value of materials. Indicate the issuing authority, the reference number and the date of issuance.
Field 10: This Field must be completed, signed and dated by the exporter. When the Certificate is completed by the producer for use by the exporter, it must be completed, signed and dated by the producer. The date must be the date the Certificate was completed and signed.
- Date modified: