Download U. S. MANUFACTURER`S AFFIDAVIT

U. S. MANUFACTURER'S AFFIDAVIT
I, (1)______________________________, declare that the articles herein specified were
manufactured by the company indicated below, and they are to the best of my knowledge
and belief, the growth, produce, or manufacture of the United States: That they were
exported from the United States from the Port of (2)____________________ on or about
(3)_______________, 20____. That they are returned without having been advanced in
value or improved in condition by any process of manufacture or other means.
I further declare that U.S. manufacturer's drawback
(4) (
(4) (
) was claimed*
) was not claimed
Item & Description
Quantity
Value
(5)______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
COMPANY OF
MANUFACTURE: (6)_____________________________________________________
ADDRESS:
(7)______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
SIGNATURE: (8) __________________________________________
__________________________________________
TITLE: (9)
__________________________________________
DATE: (10)
FILED ON CUSTOMS ENTRY NO. (11)__________________________________
* If U.S. manufacturer's drawback was claimed, please indicate below the amount of
drawback received, port and date filed.
A38 Rev. 01/14/02
U. S. MANUFACTURER'S AFFIDAVIT
INSTRUCTIONS
1. Person's name completing the declaration.
2. Port of Exporting.
3. Today's date.
4. Indicate whether drawback was claimed or not claimed.
5. Item description, quantity and value.
6. Company of manufacture.
7. Company's address.
8. Signature of U.S. party.
9. Title.
10. Today's date.
11. Will complete by CHB.
A38I Rev. 01/14/02