Example / Sample draft from the public Standard report — not a live exporter file.

Draft Certification of Origin worksheet

VG-COO-STANDARD · 2026-09-01

Filled worksheet to help complete CBP’s Certification of Origin (OMB 1651-0117) — not a signed legal certificate and not CBP’s interactive fillable PDF. Verify every field with a broker or customs before you claim preference.

Volos draft worksheet — not a signed CBP Certification of Origin

CERTIFICATION OF ORIGIN

OMB Number: 1651-0117

Select CountryMexico

BLANKET ONLY:

IMPORTER

Name:

Address:

State/Province:

Zip/Postal Code:

Country:Mexico

Phone:

Email:

Additional Information / Notes

[Buyer / importer in Mexico — fill before sending] USMCA preferential treatment may apply if rules of origin met Schedule B 8481805000 (export statistical; confirm HTSUS on the entry).

EXPORTER

Name:Example Exporter Co.

Address:

State/Province:

Zip/Postal Code:

Country:United States of America

Phone:

Email:[email protected]

PRODUCER

Same as Exporter

Name:

Address:

State/Province:

Zip/Postal Code:

Country:

Phone:

Email:

Product(s) for which preference is claimed

Blanket Period

Invoice Date	Invoice #	HTSUS #	Description	Quantity	Origin	Criterion
2026-09-01	VG-STANDARD	8481.80.50	Finished stainless-steel residential kitchen faucet, single-handle pull-down sprayer, chrome finish. Consumer plumbing fixture — not industrial process valves.	[Qty — fill]	United States of America	[confirm]

Additional product lines go on a continuation sheet.

I CERTIFY THAT:

The information on this document is true and accurate and I assume the responsibility for proving such representations. I understand that I am liable for any false statements or material omissions made on or in connection with this document;
I agree to maintain and present upon request, documentation necessary to support these representations;
The goods comply with all requirements for preferential tariff treatment specified for those goods in the USMCA Agreement; and
This document consists of 2 pages, including all attachments.

Signature:

Sign by hand before use

Name & Title:

Date:

Role:Exporter

Phone:

Email:[email protected]

PAPERWORK REDUCTION ACT NOTICE: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number. The control number for this collection is 1651-0117. The estimated average time to complete this format is 2 hours. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection Office of Regulations and Rulings, 90 K Street, NE, 10th Floor, Washington DC 20229.

Privacy Act Statement

Privacy Act Statement Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.

AUTHORITY: The U.S. Customs and Border Protection (CBP) is authorized to collect the information requested on this form pursuant to General Note 3(a)(iv) of the Harmonized Tariff Schedule of the United States (19 U.S.C. 1202) and provided for by 19 CFR Part 7.3.

PURPOSE: CBP is requesting this information to provide qualifying imported goods duty-free or reduced duty treatment as allowed under applicable free trade agreements.

ROUTINE USES: The information requested on this form may be shared outside DHS as a routine use pursuant to 5 U.S.C. 552a(b)(3) with appropriate federal, state, local, tribal, or foreign governmental agencies, or multilateral governmental organizations, to assist DHS in investigating or prosecuting the violations of, or for enforcing or implementing, a statute, rule, regulation, order, license, or treaty or when DHS determines that the information would assist in the enforcement of civil or criminal laws. A complete list of the routine uses can be found in the system of records notice associated with this form, “DHS/CBP-001 Import Information System.” The Department’s full list of system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.

CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Providing this information is voluntary. Failure to provide this information may result in the inability of CBP to make a determination on a trade benefit or a reduction in tariff.

Draft certificate-of-origin worksheet from a Volos assessment — not a legal certificate, customs entry, or FTA claim.
Layout follows CBP’s Certification of Origin template (OMB 1651-0117). This is not CBP’s interactive fillable PDF and is not a signed official form.
USMCA and several other U.S. FTAs use required data elements rather than a prescribed paper form. Some destinations still require a chamber-issued or destination-specific certificate.
Confirm origin criterion, producer, importer, and blanket period with a licensed broker or customs before you claim preference.
Draft templates only — not legal advice, a customs entry, a binding ruling, or a filed export declaration. Verify every form with a licensed broker or customs before you ship or claim preference.