Caribbean Common Market Declaration


Information Furnished in Support of Declaration of Origin (Factory Visit) Form

In order to receive certification for products manufactured within the community, this form must be completely filled in, in a legible manner by the manufacturer of the goods.  The form must then be tendered to the Trade Certification Department for assessment.  A final determination of origin status will be established upon the completion of a factory visit.  Please print or type.

  1. Line 1. Fill in the full name of the manufacturer.
  2. Line 2. Fill in the full address of the manufacturer including contact information.
  3. State the product, including harmonized system (HS) classification code for which community status is being sought.
  4. Indicate the FOB (Free on Board) export price per unit of the product.
  5. Give a brief description of the process undertaken during manufacture.
  6. a) List materials of non-community (non-CARICOM) or undetermined origin used in themanufacture of the product as well as state their HS numbers. Also indicate the value of these materials per each unit of the product, e.g. fabric, lumber, etc.
    b) List the components of non-community (non-CARICOM) or undetermined origin used in the manufacture of components as per each unit of the product; e.g. screws, nails, etc.
  7. List materials & components of community (CARICOM) origin used in the manufacture of the product as well as state their HS numbers. Also indicate the value of these materials and components as per each unit of the product.
  8. Indicate the type of retail packaging, if any, and its individual cost or CIF value.
  9. Indicate the amount of import tax/purchase tax paid for the importation of items required in the manufacture of this product.
  10. List the cost of labour, utilities, fuel and other direct costs associated with the manufacture of a unit of the item.
  11. Exterior packaging i.e. bulk packaging e.g. cartoon, bales, crates, etc.
  12. Register the percentage of dollar value per unit.
  13. Indicate the cost of haulage to the port for a specific shipment.
  14. Register the price per unit.

Notes:
The Declaration must be completed and signed by an authorized person.  The attached signature form must also be completed and attached.  Copies of supporting documents of raw material purchase must be attached.  Samples must be provided on site visit.

Persons who furnish or cause to be furnished untrue declarations render themselves liable to penalties.

Click here to download the Information Furnished in Support of Declaration of Origin (Factory Visit) Form (55.2 kB Adobe PDF)

 
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