CP-TPP CERTIFICATION OF ORIGIN

PCB-Ltd-CPTPP-Certi�cate-2-Pages-2018-12-14.ai

INFORMATION1. EXPORTER NAME AND ADDRESS

TAX IDENTIFICATION NUMBER

TAX IDENTIFICATION NUMBER TAX IDENTIFICATION NUMBER

2. BLANKET PERIOD

3. PRODUCER NAME AND ADDRESS 4. IMPORTER NAME AND ADDRESS

5. DESCRIPTION OF GOODS

FROM

6.HS TARIFF

CLASSIFICATION NUMBER

7.ORIGIN

CRITERION

TO

AUTHORIZATION

11a. AUTHORIZED SIGNATURE

11c. NAME

11b. COMPANY

11d. TITLE

11e. DATE 11f. TELEPHONE 11g. FAX

THIS CERTIFICATION MUST BE SIGNED AND DATED BY THE CERTIFIER CERTIFYING THE FOLLOWING STATEMENT:

I CERTIFY THAT THE GOODS DESCRIBED IN THIS DOCUMENT QUALIFY AS ORIGINATING AND THE INFORMATION CONTAINED IN THIS DOCUMENT IS TRUE AND ACCURATE. I ASSUME RESPONSIBILITY FOR PROVING SUCH REPRESENTATIONS AND AGREE TO MAINTAIN AND PRESENT UPON REQUEST OR TO MAKE AVAILABLE DURING A VERIFICATION VISIT, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATION.

THIS CERTIFICATE CONSISTS OF_______ PAGES, INCLUDING ALL ATTACHMENTS.

11.

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CP-TPP CERTIFICATION OF ORIGIN CONTINUATION SHEET

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5. DESCRIPTION OF GOODS

6.HS TARIFF

CLASSIFICATION NUMBER

7.ORIGIN

CRITERION

CP-TPP CERTIFICATION OF ORIGIN

PCB-Ltd-CPTPP-Certi�cate-2-Pages-2018-12-14.ai

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Important: The use of Page 1 in this document is not mandatory to ful�ll the Certi�cation of Origin requirement, as the certi�cation can be provided on any document. It is attached for your convenience as it includes all of the required data elements (listed below) to meet the CP-TPP Certi�cation of Origin requirements.

If you choose not to use Page 1, please note that what is mandatory are the following nine (9) data elements:

1. Importer, Exporter or Producer Certi�cation of Origin

Indicate whether the certi�er is the exporter, producer or importer

2. Certi�er

Provide the certi�er’s name, address (including country), telephone number and e-mail address.

3. Exporter

Provide the exporter’s name, address (including country), e-mail address and telephone number if di�erent from the certi�er. This information is no t required if the producer is completing the certi�cation of origin and does not know the identity of the exporter. The address of the exporter shall be the place of export of the good in a CPTPP country.

4. Producer

Provide the producer’s name, address (including country), e-mail address and telephone number, if di�erent from the certi�er or exporter or, if there are multiple producers, state “Various” or provide a list of producers. A person that wishes for this information to remain con�dential may state “Available upon request by the importing authorities”. The address of a producer shall be the place of production of the good in a CPTPP country.

5. Importer

Provide, if known, the importer’s name, address, e-mail address and telephone number. The address of the importer shall be in a TPP country.

6. Description and HS Tari� Classi�cation of the Good

(a) Provide a description of the good and the HS tari� classi�cation of the good to the 6-digit level. The description should be su�cient to relate it to the good covered by the certi�cation; and

(b) If the certi�cation of origin covers a single shipment of a good, indicate, if known, the invoice number related to the exportation.

7. Origin Criterion

Specify the rule of origin under which the good quali�es:

A - The good is wholly obtained or produced in or or more CPTPP country

B - The good is produced entirely in or or more CPTPP country

C - The good is produced entirely in one or more CPTPP Countries using non-originating materials and the good satis�es all applicable requirements of Annex 3-D (Product-Speci�c Rules of Origin).

8. Blanket Period

Include the period if the certi�cation covers multiple shipments of identical goods for a speci�ed period of up to 12 months. Note: if the certi�cation is on a shipment speci�c document it cannot be kept on �le and must accompany each shipment.

9. Authorized Signature and Date

The certi�cation must be signed and dated by the certi�er and accompanied by the following statement:

“I certify that the goods described in this document qualify as originating and the information contained in this document is true and accurate. I assume responsibility for proving such representations and agree to maintain and present upon request or to make available during a veri�cation visit, documentation necessary to support this certi�cation.”