Certificate of Origin | The United States-Azerbaijan Chamber of Commerce

1. Applicant and exporter

Applicant company

USACC membership

Business address

Contact name and title

Email

Telephone

Applicant role

Exporter legal name and address, if different

Manufacturer legal name and U.S. production address, if different

2. Consignee and shipment

Consignee legal name and full address

Destination country

Commercial invoice number

Invoice date

Purchase order number

Expected shipment date

Transport document number, if available

Number and type of packages

Shipping marks

Certificate format

Number of paper originals

Special wording or destination requirements

3. Goods and declared origin

Add one entry for each invoice line. Product descriptions should match the invoice. Include significant foreign components and processing in the explanation below.

Products
	Invoice line and product description SKU or model HS code, if known Quantity Unit of measure Invoice line value Declared country of origin U.S. production site for this item	Item weight

more items

Explain the U.S. manufacturing or production performed

4. Supporting documents

Commercial invoice

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Manufacturer origin declaration or supporting evidence

If the applicant is the manufacturer, its signed declaration may be submitted here.
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5. Declaration and signature

I am authorized to submit this application. I certify that the information and documents provided are accurate and complete to the best of my knowledge; that the declared origin of each product is supported by available production and sourcing information; and that this application refers to the goods and invoice identified above. I will notify USACC promptly of any material error or change. I understand that USACC may request further evidence or decline, correct, or revoke a certificate based on inaccurate information. Acceptance by the destination country is determined by its relevant authorities.

Authorized signer's full name

Title

I agree to the declaration above and intend my typed name to serve as my electronic signature.