OMB No. 1515-0204
See back of form for Paper-
work Reduction Act Notice.

DEPARTMENT OF THE TREASURY

United States Customs Service

TAX IDENTIFICATION NUMBER:

4. IMPORTER NAME AND ADDRESS

2. BLANKET PERIOD

TAX IDENTIFICATION NUMBER:

3. PRODUCER NAME AND ADDRESS

TAX IDENTIFICATION NUMBER:

1. EXPORTER NAME AND ADDRESS

19 CFR 181.11, 181.22

Please print or type

FROM

TO

DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE NORTH AMERICAN FREE TRADE AGREEMENT CERTIFICATE OF ORIGIN Please print or type 19 CFR 181.11, 181.22 O M B Number 1 5 1 5 - 0 2 0 4
  See back of form for Paperwork Reduction Act Notice. Form Assistant Page 1 of 3

Form Assistant
Page 1 of 3

Go to Form Assistant Page (1-3):

Customs Form 434 (040397)

Customs Form 434 (04 03 97)

NORTH AMERICAN FREE TRADE AGREEMENT 

CERTIFICATE OF ORIGIN

(MM/DD/YYYY)

Any data typed after screen scrolls will not print.

Any data typed after screen scrolls will not print.

(This is a mandatory field)