If you are a business owner, there may come a time when you need to provide a certificate of duty (also known as a customs declaration or invoice) to your customer. A duty certificate sample form can be helpful in getting started. This document certifies that taxes and other duties have been paid on the goods being exported. In some cases, you may also need to include the commercial invoice with your shipment. For more information on what needs to be included in your export documentation, contact your local customs office.
Question | Answer |
---|---|
Form Name | Duty Certificate Sample Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | duty slip, duty certificate format, duty certificate format for employee, on duty certificate format |
4430.01 F4/page 1 of 1
FMLA LEAVE
(to be submitted prior to reinstatement)
Employee's Name: ____________________________________ Position: ______________________
Building: _________________________________________________
Employee's serious health condition which caused him/her to take FMLA leave:
__________________________________________________________________________________
__________________________________________________________________________________
Date FMLA leave commenced: ___________________________
Date FMLA leave is set to end: ____________________________
Name of treating health care provider: _________________________________________
Medical practice (field of specialization, if any): __________________________________
THE EMPLOYEE IS ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF HIS/HER JOB, WITH
OR WITHOUT A REASONABLE ACCOMMODATION. |
Yes No |
Any restrictions or accommodations necessary to allow the employee to return to work:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________________ |
_______________________ |
Health Care Provider's Signature |
Date |
The Health Care Provider Authorization for Release of Information (see Form 4430.01 F5) or a similar
THIS IS A CONFIDENTIAL RECORD AND IT SHALL BE MAINTAINED AS SUCH
AS REQUIRED BY THE AMERICANS WITH DISABILITIES ACT.
5/04
© NEOLA 2003