North American Free Trade Agreement CERTIFICATE OF ORIGIN

North American Free Trade Agreement CERTIFICATE OF ORIGIN Please Print or Type 1 Exporter's Name and Address (Instructions Attached) 2 Blanket Period D D M M Y Y D D M M Y Y Tax Identification Number Producer's Name and Address Importer's Name and Address 3 4 Tax Identification Number: Tax Identification Number 5 Description of Good (s) 6 U.S. Tariff Classification Number 7 Preference Citation 8 Produce r 9 Net Cost 10 Country of Origin 11 I certify that: - the information on this document is true and accurate and I assume the responsibility for proving such representations. I understand that 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 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 Free Trade Agreement, and unless specifically exempted in Article 411 or Annex 401, there has been no further production or any other has the territories of the Parties; and - Thin Certificate consists of pages, including all Authorized Signature: Company Title: Company: Name: Name: Title: Date (DD/ MM/ YY): Telephone FAX: B 232E <U1593.FTW> American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc. NORTH AMERICAN FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN INSTRUCTIONS For purposes of obtaining preferential tariff treatment, 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. Please print or type. State the full legal name, address (including country) and legal tax identification number of the exporter. Legal tax identification number is : in Canada, employer number of importer/exporter number assigned by revenue Canada, in Mexico, federal taxpayer's registry number (RFC); and in the United States, employer's identification number of Social Security Number. Complete field if the Certificate covers multiple shipments of identical goods as described in Field 5 that are imported into a NAFTA county for a specified period of up to one year (blanket period). 'From' is the date upon which the Certificate becomes specified to the good covered by the blanket Certificate (it may be prior to the date of signing this Certificate). "TO" is the date upon 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. State the full legal name, address (including county) and legal tax identification number, as defined in Field 1, of the producer. If more than one producer's good is included on the Certificate , attach a list of the additional producer, including the legal name address (including county) and legal tax identification number, cross referenced to the good described in field 5. If you wish this information to be confidential , it is acceptable to state "Available to Customers upon request." If the producer and the exporter are the same, completed field with "SAME." If the producer is unknown, it is acceptable to state "UNKNOWN." State the full legal name, address (including country) and legal tax identification number, as defined in Field 1, of the producer. If more than one producer's good is included on the certificate, attached a list of the additional producers, including the legal name, name (including country) and legal tax identification number, cross referenced to the good described in Field 5. If you wish this information to be confidential, it is acceptable to state "available to customs upon request." If the producer and the exporter are the same, complete field with "SAME." If the producer is unknown, it is acceptable to state "UNKNOWN." State the full legal name, address (including country) and legal tax identification number, as defined in Field 1, of the importer. If importer is not known, state "UNKNOWN", if multiple importers, state "VARIOUS." Provide a full description of each good. The description should be sufficient to relate into the invoice description and to the Harmonized System (HS) description of the good. If the certificate cover a single shipment of a good, include the invoice number that is shown on the commercial invoice. If not known, indicate another unique reference number, such as the shipping order number. For each good described in field 5, identify the HS tariff classification to six digits. If the good is subject to a specific rule of origin in Annex 401 that requires eight digits, using the HS tariff classification on the country into whose territory the good is imported. For each good described in field 5, state which criterion (A through F) is applicable. The rules or origin are contained in chapter four and Annex 401. Additional rules are described in Annex 703.2 (certain agricultural goods), Annex 300-B, Appendix 6A (certain textile goods) an Annex 308.1 (certain automatic data processing goods and there parts). Note: in order to be entitle to preferential tariff treatment, each good must meet at least on of the certificate below. PREFERENTIAL CRITERIA A. The good is "wholly obtain or produce entirely" in the territory of one or more of the NAFTA countries, as referred to in article 415. NOTE: The purchase of a good in the necessary render it "wholly obtain or produce." If the good is in agricultural good, see also criteria F An Annex 703.2. (Reference: Article 401(a) and 415) B. The good is produced entirely in the territory of one or more of the NAFTA countries and satisfies the specific rule of origin, set out in Annex 401, that applies to its tariff specification. the rule may include the tariff change, regional value-content requirement or a combination thereof. The good must also satisfy all other applicable requirement of chapter four. If the good is an agricultural good, see also criterion F and Annex 703.2. (Reference: Article 401(b)) C. The Good is produced entirely in the territory of one or more of the NAFTA countries exclusively From originating materials. Under this criterion, one or more of the materials may not fall within the definition of "Wholly produce or obtain,