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
TAX IDENTIFICATION NUMBER:
3. PRODUCER NAME AND ADDRESS
TAX IDENTIFICATION NUMBER:
1. EXPORTER NAME AND ADDRESS
Form Assistant
Page 1 of 3
Go to Form Assistant Page (1-3):
Customs Form 434 (040397)
NORTH AMERICAN FREE TRADE AGREEMENT
CERTIFICATE OF ORIGIN
Any data typed after screen scrolls will not print.
(This is a mandatory field)