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

This questionnaire is sent to you pursuant to 19 CFR 181.72, The questionnaire will be used in

determining if the

described on the NAFTA Certificate of Origin (CO) dated

and signed by

originates under the NAFTA.  If necessary, additional information may be requested at a later date.

If this box is checked, you are being sent this questionnaire as the producer of the imported good.

If this box is checked, you are being sent this questionnaire because

If this box is checked, you are being sent this questionnaire as the exporter and also the producer of the imported good.  Complete the questionnaire.

identified you as the producer of the

material(s)  used  in  the  production  of  the  good  described  above.  

Complete the questionnaire.

19 CFR 181.72

NAFTA VERIFICATION OF ORIGIN QUESTIONNAIRE

If this box is checked, you are being sent this questionnaire as the exporter of the imported good.  If you relied upon a Certificate of Origin or written representation from the Producer to prepare your Certificate of Origin,  provide a copy of what it was that you relied  upon,  and  then  go directly to Section V and complete it.  If you relied upon your knowledge of the good, complete the questionnaire.

EXPORTER
PRODUCER OF GOOD
EXPORTER/PRODUCER
PRODUCER OF MATERIAL

The good was exported by

Complete the questionnaire.

MM/DD/YYYY

DEPARTMENT OF THE TREASURY, UNITED STATES CUSTOMS SERVICE O M B Number 1 5 1 5 dash 0 2 0 4.  See back of form for Paperwork Reduction Act Notice. N A F T A Verification of Origin Questionnaire 19 C F R 1 8 1 point 7 2 originates under the N A F T A.  If necessary, additional Information may be requested at a later date. If this box is checked, you are being sent this questionnaire as the exporter of the imported good. If you relied upon a Certified of Orgin or written representation from the producer to prepare your Certificate of Orgin, provide a copy of what it was that you relied upon, and then go directly to Section 5 and complete it. If you relied upon your knowledge of the good, complete the questionnaire. If this box is checked, you are being sent this questionnaire as the exporter and also the producer of the imported good. Complete the questionnaire. Form Assistant Page 1 of 6

Form Assistant
Page 1 of 6

Go to Form Assistant Page (1-6):

Customs Form 446 (040397)

If this box is checked, you are being sent this questionnaire as the producer of the imported good. Complete the questionnaire. identified you as the producer of the material (s) used in the production of the good described above. Complete the questionnaire.

DEPARTMENT OF THE TREASURY
United States Customs Service

Customs Form 446 (0 4 0 3 9 7)

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Any data typed after screen scrolls will not print.