United States Department of Labour
BUYING AGENCY:
BUYING AGENT'S NAME:
| I have inspected | (Factory Name) | (Address) | (Country) during the production of and after the completion of the Merchandise described below. |
I attest that the factory has the production capabilities to produce this merchandise and that during my inspection of the facility I observed the merchandise actually being produced at this facility.
Furthermore, based upon my observations and personal knowledge of the factory operation, none of the merchandise governed by this Certificate was produced, manu factured, or distributed with convict, child, indentured, or forced labor in part or whole.
The following listed merchandise has been inspected by the undersigned and is of the same quality and specification as the confirmation sample approved by the Buyer. All cartons and shoes are properly marked with the Country of Origin.
| Customer Order No. |
| Customer SKU |
| Description |
| Quantity |
| Carton Numbers |
| U.S. $ Amount |
| Date of Inspection |
| Place of Inspection |
| Carton #'s Inspected |
It is understood that the final inspection is at the discretion of the Kinney Service corporation and this signed Certificate in no way relieves the Buying Agent of re sponsibility should any claim arise concerning this shipment.
This certification has been given voluntarily and willingly on behalf of the (Buyer's Representative's Firm) and shall become a part of the official documents issued for export purposes.
| (Authorized Signature) | (Title) |