AUSFTA – DECLARATION

1 (Reproduce on Company Letterhead or stamp with company stamp below where indicated this is a legal document) AUSFTA DECLARATION This DECLARATION refers to the following consignment . Invoice Number: Bill of Lading/Airway Bill: Document Reference: I declare that this consignment described above are of USA Originating Goods , except if declared at the bottom, as defined in the US Free Trade Agreement Implementation Act 2004 and as such are entitled to the preferential rate of Customs Duty as specified in the US Free Trade Agreement Implementation (Customs Tariff) Act 2004. Section 153YB Customs Act Goods wholly obtained or produced entirely in the Section 153YC Customs Act Goods produced entirely in the or in the and Australia from originating materials. Section 153YE Customs Act Goods (exept clothing and textiles) produced entirely in the or in the and Australia from non-originating materials. Section 153YF Customs Act Goods that are chemicals, plastics or rubber.

2 Section 153TH Customs Act Goods that are clothing or textiles produced in the or the and Australia from non-originating materials or a combination of non-originating and originating materials (please tick the relevant box which is applicable to your supply) If required by Australian Customs, I am able to produce evidence that these US Originating Goods do meet the criteria as specified above. Please claim preference YES / NO Date: Name Printed: Company Name: Authorised Signature