this Certificate consists of pages, including all attachments.
For the purpose of obtaining preferential tariff treatment for goods of the Caribbean Basin beneficiary countries, this document must be
completed legibly and in full by the exporter and be in the possession of the importer at the time the CBTPA claim is made. The
producer may voluntarily complete a certificate for use by the exporter in filling out their own certificate.
Note: The purchase of a good in the Caribbean Basin beneficiary countries does not render it originating. If the origin of the good
cannot be determined, the exporter must assume that the good does not originate.
United States-Caribbean Basin Trade Partnership Act (CBTPA)
CERTIFICATE OF ORIGIN
19 CFR 10.234, 10.236
See Reverse for Instructions and a list of the tariff items with which this certificate may be used.
PLEASE PRINT OR TYPE. SEE INSTRUCTIONS ON REVERSE.
11. I certify that:
PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to
carry out the laws and regulations administered by the U.S. Customs and Border Protection. This form is used by exporters/importers for the purpose
of obtaining preferential tariff treatment for goods of the Caribbean Basin beneficiary countries. It is mandatory. The estimated average burden
associated with this collection of information is 15 minutes per responds depending on individual circumstances. Comments concerning the accuracy
of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Asset Management,
Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0083), Washington, DC 20503.
3. Producer's Name and Address
1. Exporter's Name and Address
4. Importer's Name and Address
2b) Blanket Period
Invoice or other unique reference number
2a) Single Importation
2. COMPLETE EITHER 2