Organic Importer Certification Statement

Importer Information

Importer Name:
Address:
City, State/Province, Zip/Postal Code:
Country:
Contact Person:
Phone/Email:

Exporter Information

Exporter Name:
Address:
Country:
Certification Body:
Certificate Number:

Shipment Details

Product Description:
Quantity:
Lot/Batch Numbers:
Country of Origin:
Port of Entry:
Date of Arrival:

Certification Statement

I hereby certify that the above products have been imported and handled in accordance with the applicable organic regulations, and that all information provided in this statement is true and accurate to the best of my knowledge.

Authorized Signature

Date