1. Blanket Period:(dd/mm/yyyy)	2. Single Shipment:
From: 01/08/2020 To: 01/12/2021	Invoice Number:
3. Certifier's Name and Address:	4. Exporter's Name and Address:
International Trade Company	International Trade Company
Mrs.Jane Little	Mrs.Jane Little
Branch Manager	Branch Manager
567 DoralBeach	567 DoralBeach
Florida, USA	Florida, USA
Telephone:+ 1 716 678 34567	4565678
E-Mail Address: xyz	Telephone:+ E-Mail Address:
Certifying Party: Importer
5. Producer's Name and Address:	6. Importer's Name and Address:
VARIOUS	My Company INC 3456 Weston Avenue Unit 345 Toronto, ON L7B 0K8
Telephone:	Telephone:900- 679-9006
E-Mail Address:	E-Mail Address: c..o@mycompany.com
7a. Part Number	7b. Description of the Goods	8. HS Tariff Classification	9. Origin Criterion	10. Country of Origin
N/A	Pizza Sauces	2103.21	B	USA
11. I CERTIFY THAT: The goods described in this document qualify as originating and the information contained in this document is true and accurate. I assume responsibility for proving such representations and agree to maintain and present upon request or to make available during a verification visit, documentation necessary to support this certification. This Certification consists of 1 pages, including all attachments.
Authorized Signature:	Company: My Company Inc
Name: Leovil Jhonson	Title: Customer Service Manager
Date:(dd/mm/yyyy)	Email:	Telephone:
12/10/2020		n/a

Field	Description	Ok or not Ok. Why
1	Certifier
2	Certifiers Information
3	Exporter
4	Producer
5	Importer
6	Description- HS- Invoice #
7	Criteria
8	Blanket Period
9	Signature- date and Declaration

• Will you accept this Certification of Origin as valid?

Yes or No and explain