US flag Official website of the Department of Homeland Security

Certification of Origin Template

Document Posting Date: 
October 15, 2015

This document may qualify as a “guidance document” as set forth in Executive Order 13891 and interpretations thereof; such guidance documents are not binding and lack the force and effect of law, except as authorized by law or as incorporated into a contract. This document is being posted to this portal to provide stakeholders with useful information.

For best results, please save the Certification of Origin Template PDF to your computer.

Most free trade agreements can be supported by a certification attesting to the imported product's originating status.  This attestation is called a Certification of Origin.  The PDF provided on this page is a fillable template that demonstrates how such a Certification of Origin can be structured, and which users may elect to use.  Its use, or adherence to its structure, however, is in no way compulsory. Nevertheless, pursuant to the relevant regulations, all of the data elements specified therein must still be provided upon request to CBP in connection with a claim for preferential tariff treatment.

Changes from 4/29/2015 file version: The 10/15/2015 file updates the 4/29/2015 file version by extending OMB expiration date for three and a half years (expires on 9/30/2018 instead of 3/31/2015).

The "Expiration Date: 9-30-2018" should be disregarded. This template remains acceptable for importations and exportations until further notice.

Last modified: 
February 28, 2020