Certificate of Origin Korea-US Free Trade Agreement 1. EXPORTER

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Certificate of Origin Korea-US Free Trade Agreement 1. EXPORTER Powered By Docstoc
					                                      Certificate of Origin
                                 Korea-US Free Trade Agreement
                         Name

                         Address                                         2. BLANKET PERIOD

 1. EXPORTER           Telephone
                                                                                  From: __ __ /__ /__ To: __ __ /__ /__
                           Fax                                                             YYYY/MM/DD to         YYYY/MM/DD
                         E-mail

                         Name                                                                    Name

                         Address                                                                Address

3. PRODUCER            Telephone                                        4. IMPORTER            Telephone

                           Fax                                                                    Fax

                         E-mail                                                                  E-mail

                                    5. LIST OF PRODUCT(S) SUBJECT TO PROOF OF ORIGIN

                                                                                               Preference
Serial No.    Description of Good(s)          Quantity & Unit           HS No (6 Digits)                            Country of Origin
                                                                                                Criterion




                                                        6. 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,
    all persons 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 Korea -United State of America Free Trade Agreement.

    This Certificate consists of ______ pages, including all attachments.


 Authorized Signature:                                                   Company:


 Name:                                                                   Title:


Date:    YYYY/MM/DD                                                      Telephone :                      Fax:


1) Originating goods (wholly obtained or produced) in accordance with Article 6.1(a) of the Agreement: WO
2) Originating goods (undergoes an applicable change in tariff classification or regional value content etc) in accordance with Article
   6.1(b) of the Agreement: PSR
3) Originating goods (produced exclusively from originating materials) in accordance with Article 6.1(c) of the Agreement: PE
         Instructions on Completion of Certificate of Origin
                               Recommended Form under KORUS FTA

Box #            Data Element                                          Instructions on Completion

  1     Exporter                             The legal name, address, telephone no., fax no. and e-mail address of the
                                             exporter of record of the good (If different from the producer)

  2     Blanket Period                       Provide the blanket period in "from YYYY/MM/DD to YYYY/MM/DD" format
                                             (12 month maximum from the date of the Certification)

  3     Producer                             The legal name, address, telephone no., fax no. and e-mail address of the
                                             producer of record of the good (If known)

  4     Importer                             The legal name, address, telephone, fax and e-mail of the importer of record of
                                             the good (If known)

        Serial No.                           To indicate serial no. in case where there are more than two products subject to
                                             proof of origin

         Description of Good(s)        (★)   Description of the good(s) shall be sufficiently detailed to relate it to the invoice


        Quantity & Unit                      The Quantity & Unit of the good(s) shall be indicated to relate it to the invoice

  5                                          HS tariff classification, to six or more digits, as specified for each good in the
         HS2002 No.                    (★)
                                             Rules of Origin (2002 HTS-Korea)
                                             To indicate the preference criterion applied to the good(s);
        Preference Criterion                   - Originating goods in accordance with Article 6.1(a) : ‘WO’
                                               - Originating goods in accordance with Article 6.1(b) : ‘PSR’
                                               - Originating goods in accordance with Article 6.1(c) : ‘PE’

         Country of Origin            (★)    Indicate ‘US’, ‘USA’, ‘United States’ or ‘United States of America’


        Observations                         If applicable, provide observations in relation to the proof of origin


        Authorized Signature

        Company
                                             The signee must have access to the underlying records and the legal authority to
                                             bind the company
         Name                          (★)
  6
        Title

         YYYY/MM/DD                    (★)   The date of the certification


        Telephone
                                             The telephone no. and fax no. of the signee of the good
        Fax

        ※ Denial of preferential tariff treatment may be appealed when compulsory elements (with ‘★’) are incomplete.

				
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posted:3/26/2013
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