UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA)

CERTIFICATION OF ORIGIN
Crane Client Name / Code:

1. Blanket Period: (MM/DD/YYYY) 2. Single Shipment:

From: Invoice Number:
To:

3. Certifier's Name and Address: 4. Exporter's Name and Address:

Telephone: Telephone:
E-Mail Address: E-Mail Address:
Tax Identification Number: Tax Identification Number:
5. Producer's Name and Address: 6. Importer's Name and Address:

Telephone: Telephone:
E-Mail Address: E-Mail Address:
Tax Identification Number: Tax Identification Number:

6. Part Number 7. Description 8. HS Tariff 9. Origin 10. Qualification 11. Country of 12. Accumulation
of Good(s) Classification Criteria Method Origin Value
(USD)

Field 13- 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 this certification.
* The goods originated or are considered to have originated in the territory of one or more of the parties, and comply with the origin
requirements specified for those goods in the United States-Mexico-Canada Free Trade Agreement; there has been no
no further production or any other operation outside the territories of the parties, other than unloading, reloading, or any other
operation necessary to preserve the goods in good condition or to transport the goods to the territories of the parties; the goods remained under the
control of the customs authorities while in the territory of a non-party; and
* I also agree to notify any party provided with this certificate of any changes that might adversely impact a certification previously given.
*This certification consists of pages, including all attachments.

Authorized Signature: Company:

Name: Title:

Date: (MM/DD/YYYY) Certifier Type (importer, Exporter, Producer): Contact Information:

 UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA)
Certification of Origin (Continuation)

Crane Client Name/ Code Year: 2020

Product Information HS Tariff Origin Certification Qualification Country Accumulation

Part Number Supplier Product Code Description of Good(s) Number Criteria Indicator Method of Origin Value

Printed: 04/18/2023 - (LICG12/121213) Page 2 of 3

 UNITED STATES-MEXICO-CANADA FREE TRADE AGREEMENT (USMCA)
CERTIFICATION OF ORIGIN INSTRUCTIONS

Instructions This document must be completed legibly by the Exporter and be in the possession of the Importer at the time the declaration is made in order to
qualify for preferential treatment under the United States-Mexico-Canada Free Trade Agreement. This document may also be completed
voluntarily by the Producer for use by the Exporter in preparing its own Certification of Origin. Please see below for guidance on the Certificate
fields. For questions, please reach out to your regional Customs Manager or email [email protected].

Field 1 BLANKET PERIOD Blanket Period: "FROM" is the date upon which the certification becomes applicable to the good covered by the blanket Certification
"TO" is the date upon which the blanket period expires. In no instance should that certification exceed a 12-month period, and any information
provided should be updated in the event any previously-issued certification no longer applies. Complete this field if applicable.

Field 2 SINGLE SHIPMENT: If the certification is only applicable to a single shipment this should be indicated by typing "YES" to the right of Single Shipment
and providing the Invoice Number applicable to the single shipment. Complete this field if applicable.
Field 3 CERTIFIER'S NAME AND ADDRESS (mandatory_ - Provide the Certifier’s name, title, address, e-mail address, telephone number and the tax ID
number. Indicate whether the Certifier is the Exporter, or Producer, or Importer in accordance with Article 5.2 (Claims for Preferential Treatment) of
the USMCA. d.
https://ustr.gov/sites/default/files/files/agreements/FTA/USMCA/Text/05_Origin_Procedures.pdf

Legal tax ID number is defined as:

Canada: employer number or importer/exporter number assigned by Revenue Canada
Mexico: federal taxpayer’s registry number (Registro Federal de Contribuyentes)
United States: employer’s identification number or Social Security number

Field 4 EXPORTER'S NAME AND ADDRESS -Provide the Exporter’s name, address, e-mail address, telephone number, and tax ID number if different from the
Certifier or “N/A” or “Various” or “Same as Certifier”. This information is not required if the Producer is completing the certification of origin and does
not know the identity of the Exporter. The address of the Exporter shall be the place of export of the good in a Party’s territory.

Field 5 PRODUCER'S NAME AND ADDRESS -Provide the Producer’s name, address, e-mail address, telephone number and the Tax ID number, if different
from the Certifier or Exporter or, if there are multiple Producers, state “Available upon request by the importing authorities” or “Same as Certifier”,
“Various”, or provide a list of producers.

Field 6 IMPORTER'S NAME AND ADDRESS - State the full legal name, address, e-mail address, telephone number, and tax ID number, as defined for the
Certifier or “Same as Certifier". The address of the Importer shall be in a Party’s territory. If there are multiple importers, state “Various”.

Field 7 PART NUMBER AND DESCRIPTION OF GOODS - Provide the part number and description of each good subject to the certification. The description
should be sufficiently detailed such that it can be related to the invoice description and to the Tariff Number/ Harmonized System (H.S.) description of
the good. The description can include part number references but should also provide a description of the item sufficient to identify and associate it
with the Tariff Number.

Field 8 HS TARIFF NUMBER - For each good covered under this certificate, identify the HTS classification to six digits as specified for each good in the Rules of
Origin in the USMA. If the good is subject to a specific rule of origin that requires eight digits, identify as eight digits.

Field 9 ORIGIN CRITERIA - For each good described in the certification, state which criteria (A through D) is applicable. The rules of origin are contained in
Chapter Four and Article 4.2. In order to be entitled to preferential tariff treatment, each good must meet at least one of the criteria below: A, B, C, or
D
Note: If the item does not meet the applicable Rule of Origin for USMCA (not eligible good), please leave this field blank.
https://ustr.gov/sites/default/files/files/agreements/FTA/USMCA/Text/04-Rules-of-Origin.pdf

(a) Wholly obtained or produced entirely in the territory of one or more of the Parties, as defined in Article 4.3;
(b) Produced entirely in the territory of one or more of the Parties using non-originating materials provided the good satisfies all applicable
requirements of Annex 4-B (Product-Specific Rules of Origin);
(c) Produced entirely in the territory of one or more of the Parties exclusively from originating materials; or
(d) Except for a good provided for in Chapter 61 to 63 of the Harmonized System:
(i) Produced entirely in the territory of one or more of the Parties;
(ii) one or more of the non-originating materials provided for as parts under the Harmonized System used in the production of the good cannot
satisfy the requirements set out in Annex 4-B (Product-Specific Rules of Origin) because both the good and its materials are classified in the same
subheading or same heading that is not further subdivided into subheadings or, the good was imported into the territory of a Party in an unassembled
or a disassembled form but was classified as an assembled good pursuant to rule 2(a) of the General Rules of Interpretation of the Harmonized
System; and
(iii) the regional value content of the good, determined in accordance with Article 4.5 (Regional Value Content), is not less than 60 percent if the
transaction value method is used, or not less than 50 percent if the net cost method is used;
and the good satisfies all other applicable requirements of this Chapter.

Field 10 QUALIFICATION METHOD (only if applicable)- For each good certified, only where the good is subject to a regional value content (RVC) requirement,
indicate "NC" if the RVC is calculated according to the net cost method; where transaction value was used indicate “TV”; where tariff shift alone
applied, use “TS”. If the Rule of Origin is a combined tariff shift/RVC rule, indicate "NC" where net cost was used, or indicate “TV” where transaction
value was used. If the good is produced entirely in the territory of one or more of the USMCA countries exclusively from originating materials, use
“NO”
Note: If the item does not meet the applicable Rule of Origin for USMCA (not eligible good), please leave this field blank.

Field 11 COUNTRY OF ORIGIN - Identify the name of the country of production for each good listed in this certification as a result of which the preferential rate
of duty applies. If the country of production is other than "US", "CA" or "MX" please provide the 2-digit ISO country code for the country of
production.

Field 12 ACCUMULATION VALUE (if applicable) - Where a good undergoes production within the USMCA Territory but that good does not meet the applicable
Rule of Origin, identify that portion of the good's value which qualifies as originating consistent with Article 4.11 (Accumulation) of the USMCA. Report
the value in USD currency.
https://ustr.gov/sites/default/files/files/agreements/FTA/USMCA/Text/04-Rules-of-Origin.pdf

Field 13 CERTIFICATION - This document must be completed, signed, and dated by the Certifier. The date must be the date the Certification was completed
and signed. State the legal name, address, telephone, and e-mail address of the responsible official or authorized agent of the Certifier. The
certification can accept an electronic or digital signature, as long as it is an actual representation of the signer’s signature and not a signature font.
The total number of pages of the certification should be provided where on the main page it states "*this Certification consists of __ pages, including
all attachments."

Reference Complete legal text of the USMCA agreement and Rules of Origin can be found here:
https://ustr.gov/trade-agreements/free-trade-agreements/united-states-mexico-canada-agreement/agreement-between