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
described on the NAFTA Certificate of Origin (CO) dated
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.
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.
The good was exported by
Complete the questionnaire.
Form Assistant
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Go to Form Assistant Page (1-6):
Customs Form 446 (040397)
DEPARTMENT OF THE TREASURY
United States Customs Service
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