Certificate of Origin
Korea-US Free Trade Agreement
1. EXPORTER
Name
2. BLANKET PERIOD
From: __ __/__ /__ To: __ __/__ /__
YYYY/MM/DD toYYYY/MM/DD
Address
Telephone
Fax
E-mail
3. PRODUCER
Name
4. IMPORTER
Name
Address
Address
Telephone
Telephone
Fax
Fax
E-mail
E-mail
5.LIST OF PRODUCT(S) SUBJECT TO PROOF OF ORIGIN
Serial No.
Description of
Good(s)
Quantity & Unit
HS No (6 Digits)
Preference
Criterion
Country of Origin
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)
5
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
HS2002 No.(★)
HS tariff classification, to six or more digits, as specified for each good in the
Rules of Origin (2002 HTS-Korea)
Preference Criterion
To indicate the preference criterion applied to the good(s);
- 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’
6
Observations
If applicable, provide observations in relation to the proof of origin
Authorized Signature
The signee must have access to the underlying records and the legal authority to
bind the company
Company
Name(★)
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.
