Rutherford Global Logistics

1 north american free trade agreement CERTIFICATE OF ORIGIN (Instructions on Reverse)Please print or typePROTECTED (When Completed)1. Exporter Name and Address:2. Blanket Period: (dd / mm / yy)From:To:Tax Identification Number:Tax Identification Number:Tax Identification Number:3. Producer Name and Address:4. Importer Name and Address:5. Description of Good(s):6. HS Tariff Classification Number 7. Preference Criteria 8. Producer 9. Net Cost 10. Country of Origin11. I certify that:Authorized Signature:Company:Name: (print or type)Title:Date: (dd/mm/yy)Telephone:Fax:- the information on this document is true and accurate and I assume the responsibility for proving such presentations.

2 I understand that I am liable for any false statements or material omissions made on or in connections with this document. - I agree to maintain, and present upon request, documentation necessary to support this Certificate, and to inform in writing, all persons to whom the Certificate was given of any changes that would affect the accuracy of validity of this Certificate. - the goods originated in the Territory of one or more of the Parties, and comply with the origin requirements specified for those goods in the north american free trade agreement , and unless specifically exempted in Article 411 or Annex 401, there has been no further production or any other opertation outside the Territories of the this Certificate consists of pages, including Global Logistics offices and warehouses across Canada - partners around the worldB 232EA B C Company Ltd.

3 1234 Main Street City, State, Country, Postal Code01 / 01 / 200__31 / 12 / 200 __Do Not Exceed One YearExporter Tax : SAME, or UNKNOWN, or "Available to Customs upon request"show if Producer namedshow full name and address of Importer, state: UNKNOWN, or VARIOUS show if Importer namedshow full description as goods would appear on commercial invoice or tariff desc. Leather Cowboy Boots - model 1A B No (2) No US - Invoice No. 12345 EXAMPLE ONLY instructions on reverseshow 6 digits of HS tariff (8 digits may be required on some items.)show A, B, C, D, E, or F as indicated on show criteria 1, 2, or 3 if not the Producer,otherwise state RVC required, state NC if Net Cost method US, MX, CA, or JNT as full legal company name<--- show number of pages if more than be signed by a company officer or a "knowledgeable" personprint or type name of signatorystate corporate title of signatorydate certificate completedfull telephone numberfull fax number