Manufacturer Statement Of Origin Template

Statement of Origin

The information provided is intended solely as a general example for informational purposes. It is not legal advice and should not be relied upon as a substitute for consulting a qualified professional specializing in automotive or manufacturing documentation. Regulations and requirements may vary depending on the jurisdiction, and modifications may be necessary to ensure compliance with local laws. The use of this example is at the user’s own risk, and no liability is assumed for errors, omissions, or consequences resulting from its use without professional review.

This sample template for a Manufacturer Statement of Origin is provided for informational purposes only and may vary slightly depending on specific circumstances and applicable regulations. Please customize accordingly.

Manufacturer Statement of Origin Sample

Parties Involved:

Manufacturer: ABC Manufacturing Inc.
Address: 789 Industrial Drive, Springfield, IL 62704

Authorized Distributor: XYZ Distributors LLC
Address: 456 Commerce Lane, Chicago, IL 60616

Description of the Product:

The product covered by this statement is a batch of Model XYZ-1000, serial numbers 123456 to 123499, manufactured at ABC Manufacturing Inc.’s Springfield facility, conforming to applicable standards and specifications.

Statement of Origin:

This is to certify that the aforementioned products originate from ABC Manufacturing Inc., produced in accordance with the relevant quality standards, and are intended for international shipment and distribution.

Certification:

The undersigned certifies that the information provided herein is correct to the best of their knowledge and that the products described meet the necessary requirements for origin certification.

Springfield, ______________________