Duty Certificate Sample Form PDF Details

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.

QuestionAnswer
Form NameDuty Certificate Sample Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesduty slip, duty certificate format, duty certificate format for employee, on duty certificate format

Form Preview Example

4430.01 F4/page 1 of 1

FITNESS-FOR-DUTY CERTIFICATION

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 HIPAA-compliant release form from the health care provider is required.

THIS IS A CONFIDENTIAL RECORD AND IT SHALL BE MAINTAINED AS SUCH

AS REQUIRED BY THE AMERICANS WITH DISABILITIES ACT.

5/04

© NEOLA 2003