UNITED STATES MEXICO CANADA AGREEMENT (USMCA)
CERTIFICATION OF ORIGIN
1. CERTIFIER TYPE (INDICATE "X")
IMPORTER
EXPORTER
PRODUCER
2. CERTIFIER NAME, ADDRESS, PHONE, AND EMAIL
NAME
ADDRESS
COUNTRY
EMAIL
X
BLANKET PERIOD
(MM/DD/YYYY)
FROM:
10/26/2021
TO:
10/26/2022
3. EXPORTER NAME, ADDRESS, PHONE, AND EMAIL
NAME
Agamino Life Chemicals LTD
Agamino Life Chemicals LTD
2608 Granville Street, Unit 330 V6B3H8ADDRESS
7782392756
Canada
PHONE
hello@soapstand.com
TAX IDENTIFICATION NUMBER 793531492RM0001
COUNTRY
EMAIL
PHONE
TAX IDENTIFICATION NUMBER
4. PRODUCER NAME, ADDRESS, PHONE, AND EMAIL
5. IMPORTER NAME, ADDRESS, PHONE, AND EMAIL
NAME
NAME
Agamino Life Chemicals LTD
ADDRESS
ADDRESS
COUNTRY
PHONE
COUNTRY
EMAIL
PHONE
EMAIL
TAX IDENTIFICATION NUMBER
TAX IDENTIFICATION NUMBER
6.
DESCRIPTION OF GOOD(S)
7.
HTS
8.
ORIGIN
CRITERION
9.
PRODUCER
(YES/NO)
10.
METHOD OF
QUALIFICATION
11.
COUNTRY
OF ORIGIN
Smart liquid vending refill machine
8476.89.00.00.
B
Yes
NC
Canada
SEE ATTACHED CONTINUATION SHEET(S)
I CERTIFY THAT THE GOODS DESCRIBED IN THIS DOCUMENT QUALIFY AS ORIGINATING AND THE INFORMATION CONTAINED IN THIS DOCUMENT IS TRUE
AND ACCURATE. I ASSUME RESPONSIBILITY FOR PROVING SUCH REPRESENTATIONS AND AGREE TO MAINTAIN AND PRESENT UPON REQUEST OR TO MAKE
AVAILABLE DURING A VERIFICATION VISIT, DOCUMENTATION NECESSARY TO SUPPORT THIS CERTIFICATION
THIS CERTIFICATE CONSISTS OF
12a. AUTHORIZED SIGNATURE
12.
12c. NAME
PAGES, INCLUDING ALL ATTACHMENTS.
12b. COMPANY
Digitally signed by Andy Chou
Andy Chou
DN: cn=Andy Chou, o=Drinkfill, ou,
email=andy@drinkfill.com, c=CA
Date: 2021.10.26 19:12:19 -07'00'
12d. TITLE
Andy Chou
12e. DATE (MM/DD/YYYY)
10/26/2021
12f. TELEPHONE NUMBER
7782392756
Agamino Life Chemicals LTD
CEO
12g. EMAIL
andy@drinkfill.com
USMCA CERTIFICATE V3