Certificate Of Origin Template For Cargo Logistics - Free Download
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DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
CERTIFICATE OF ORIGIN
(ARTICLES SHIPPED FROM INSULAR POSSESSIONS,
EXCEPT PUERTO RICO, TO THE UNITED STATES )
19 CFR 7.3
OMB No. 1651-0016
4. NAME OF PERSON COMPLETING CERTIFICATE
5. NAME OF FIRM
9. DESTINATION (Port of)
11. LOCATION OF CONSIGNEE (City and State)
3. CERTIFICATE NO.
6. SHIPPERS EXPORT DEC. NO.
10. CONSIGNED TO
7. DATE FILED
8. CARRIER (Vessel or Airline)
DESCRIPTION OF ARTICLES
FOREIGN MATERIALS MATERIALS DESCRIBED IN GENERAL NOTE 3 (a)(iv)(B)(2)
Date Imported into
Date Incorporated into
20. INSULAR POSSESSION WHERE MERCHANDISE WAS PRODUCED OR MANUFACTURED 21. INSULAR POSSESSION OF WHICH MATERIALS ARE THE GROWTH, PRODUCT, OR MANUFACTURE
22. ADDRESS OF SHIPPER
23. SIGNATURE OF SHIPPER
I declare that I am the person named above, acting in the capacity indicated; that the description and other particulars of the
merchandise specified above are correct as set forth in this certificate; that the said merchandise was produced or manufactured in
the insular possession named above, and from the materials grown, produced, or manufactured in the insular possession also named
above, or of the United States, or of both; that if foreign materials were used therein, their description and value are shown above.
I hereby certify that I have investigated the foregoing
statements and am satisfied that they are correct to
the best of my knowledge and belief.
24. DATE 25. SIGNATURE OF CBP OFFICER
SEE BACK OF FORM FOR FOOTNOTES AND PAPERWORK REDUCTION ACT NOTICE.
CBP Form 3229 (06/09)