Proof of Origin of Imported Goods Regulations (SOR/98-52)
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Regulations are current to 2024-10-30 and last amended on 2024-10-07. Previous Versions
SCHEDULE(Subsections 4(2) and (3))Exporter’s Statement of Origin
I certify that the goods described in this invoice or in the attached invoice # 
were produced in the beneficiary country of and that at least per cent of the ex-factory price of the goods originates in the beneficiary country/countries of .
- Name and title
- Corporation name and address
- Telephone and fax numbers
- Signature and date (day/month/year)
- Date modified: