Download Australia-United States Free Trade Agreement (AUSFTA)

(COMPANY LETTERHEAD)
Australia-United States Free Trade Agreement (AUSFTA)
Statement of United States origin
I ____________________ of (company name) hereby state that the nominated goods
below, meet the requirements of the legislation of the AUSFTA. I wish to claim the
preferential duty rate using the rule type as marked.
___ 1) Section 153YB rule type W.O. -goods wholly obtained- relates to goods mined,
grown, bred, fished etc
___ 2) Section 153YC rule type P.O.M. -goods produced entirely in the US from
originating materials- relates to goods made in the US from US materials
___ 3) Section 153YE rule type P.S. -goods (except clothing and textiles) produced
entirely in the US from non-originating materials- relates to goods made in the US from
US materials and materials from other countries
___ 4) Section 153YF rule type P.S. –goods that are chemicals, plastics or rubber
produced entirely in the US from non-originating materials
___ 5) Section 153YH rule type P.S. –goods that are clothing or textiles produced
entirely in the US or the US and Australia from non-originating materials or a
combination of originating materials and non-originating materials.
I agree to maintain and present on request, documentation necessary to support this
statement.
Shippers name:
Product name/description:
Name:
Date:
Signature: