Product Manual

OMB No. 1515-0204
See next form Paper-
work Reduction Act Notice.
DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE
NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN
19 CFR 181.11,181.22
1. Exporter's Name and Address:
Metal tech Omega II
1735 St-Elzear
Laval,
CANADA, tel: [phone]
H7L 3N6 TAX IDENTIFICATION NUMBER: 65-0791611
3. Producer's Name and Address:
METAL TECH
1735 B ST-ELZEAR W.
LAVAL, QC
CANADA
H7L 3N6 TAX IDENTIFICATION NUMBER: 65-0791611
2. Blanket Period:
(DD/MM/YYYY)
From
to
31-12-2010
4. Importer's Name and Address:
TAX IDENTIFICATION NUMBER:
5.
Description of Good(s)
6.
HS Tariff
Classification
Number
7.
Preference
Criteria
8.
Producer
9.
Net Cost
10.
Country of
Origin
MINI INTERIOR SCAFFOLD
SCAFFOLDING
7308.40 NO NO CN
MAXI SQUARE SCAFFOLD
ECHAFAUD/PLATE-FORM/ GATE/ALUMINIUM
7616.99 no CN
BRACE
SCAFFOLDING
7308.40 B YES NO CA
PLATFORM
ALU/SCAFFOLD/STEPLADDER/PLATFORM-GATE
7616.99 B YES NO CA
SCREWJACK
SCAFFOLDING
7308.40 NO NO CN
8" CASTER FOR SCAFFOLDING
CASTERS FOR SCAFFOLDS
8302.20 NO NO CN
SCAFFOLD FRAME
SCAFFOLDING
7308.40 B YES NO CA
I certify that :
-
the information on this document is true and accurate and I assume 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 originated in the territory of one or more of the Parties and comply with the origin requirements specified for those goods in the North American Free Trade
Agreement, and unless specifically exempted in Article 411 or Annex 401, there has been no further production or any other operation outside the territories of the Parties; and
-
this Certificate consists of 1 pages, including all attachments.
11a. Authorized Signature:
11c. Name:
11e. Date (DD/MM/YY
19-03-2010
11f. Telephone:
450-663-2263
11b. Company:
Metaltech Omega II inc.
11d. Title:
coordonator
FAX:
450-663-5587
Customs Form 434
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