Formulario canada

Canada-Chile Free Trade Agreement

Accord de libre-échange Canada-Chili

Acuerdo de Libre Comercio Chile-Canadá

CERTIFICATE OF ORIGEN (Instructions on reverse)

CERTIFICAT D'ORIGINE(Instructions au verso)

CERTIFICADO DE ORIGEN (Instrucciones al reverso)

Please Print or Type - Veuillez écrire en majuscules ou á la machine - Llenar a máquina o con letra de molde 1 Exporter´s Nameand Address: 2 Blanket Period: Nom et adresse de l´exportateur: Périods globale: Nombre y dirección del exportador Período que cubra:

D From Du De Tax identification Number Numéro d´identificationaux fins de l´impót Número de Rol Unico Tributario 3 Producer´s Name and Address: Nom et adresse du Producteur: Nombre y domicilio del productor:

J

M

Y- A To Au A

D- J

M

Y- A

4Importer´s Name and Address: Nom et adresse de l´importateur: Nombre y domicilio del importador:

Tax identification Number Numéro d´identification aux fins de l' impot Número de Rol Unico Tributario 5Description of Good(s) - Description des produits - Descripción del (los) bien (es) 6

Tax identification Number Numéro d´identification aux fins de l' impot Número de Rol Unico Tributario HS TariffClassification N° de classement tarifaire SH Clasificación Arancelaria 7 Preference Criterion Critére de preference Criterio para trato preferencial 8 Producer Producteur Productor 9 RVC TVR VCR 10Country of Origin Pays d´origine Pais de origen

11 I certify that: - The Information on this documet is true and accurate and I assume the responsability for proving such representations. Iunderstand that I am liable for any false statements or material omissions made on or in connection with this document; - I agree to mantain, and present upon request, documentation necessary to support thisCertificate, and to inform, in writting, 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...