Instructions for

Toxic Substances Control Act (TSCA) Certification

Each one of the TSCA Certifications attached has a specific intended purpose:

1. The version with the Waybill or reference number section is to be used for single-shipment certifications
ONLY

• Please enter the shipment international air waybill number (IAWB) of the shipment in this area

• Note that completing the Company name, Company address, and Certifier title fields is OPTIONAL

• The single-shipment certifications are to be included with the shipment documents at the time the
shipment is created.

• The single-shipment certifications can also be sent directly to the trace agent at
paperwork@fedex.com. The shipment’s air waybill number should be included in the subject-line of
the email.

2. The annual certification is the version with the “valid for twelve months” language and is to be used for filing
multiple commodity TSCA articles with FedEx Trade Networks (FTN) ONLY

• Include the date at the top of the form

• Check either positive or negative certification for the TSCA articles being submitted

• ALL POSSIBLE TSCA-regulated items should be included, not just the items for a particular
shipment

• All three columns do NOT have to be completed; just the ones you use for your specific TSCA
article(s)

• Note that completing the Company name, Company address, and Certifier title information blocks
below the three columns is OPTIONAL, but the customer's details are required in order to update or
create the customer’s profile.

• Once completed, the annual version can be sent to supportservices@fedex.com.

Please note: Only the annual version (covering the 12-month period) can be sent to this contact
address.

Instruction Sheet
Revised 04-20-22
Toxic Substance Control Act (TSCA) Certification

Date: _____________

Waybill or other reference (invoice/lot) number: _______________________________

Positive Certification

I certify that all chemicals substances in this shipment comply with all applicable rules or orders under
TSCA and that I am not offering a chemical substance for entry in violation of TSCA or any applicable rule
or order thereunder.

OR

Negative Certification

I certify that all chemicals in this shipment are not subject to TSCA.

Company name: _________________________________________________(optional)

Company address: _________________________________________________(optional)

Certifier name: _________________________________________________

Certifier title: _________________________________________________(optional)

Certifier phone number: __________________________________________________

Certifier email address: __________________________________________________

Certifier signature: __________________________________________________

Product description

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

5. ____________________________________________________

6. ____________________________________________________

7. ____________________________________________________

If the certifier is unsure if their chemical substance is subject to TSCA compliance, contact the
Environmental Protection Agency, TSCA Hotline at 1.202.554.1404 or 1.202.554.5603 between 8:30
a.m. and 5:00 p.m., or TSCA-Hotline@epa.gov

09/2019
Toxic Substance Control Act (TSCA) Certification
Date: ____________
This certification is valid for twelve months from the date submitted and will only cover the products listed.

Check only one:

Positive Certification
I certify that all chemical substances in this shipment comply with all applicable rules or orders under TSCA and that
I am not offering a chemical substance for entry in violation of TSCA or any applicable rule or order thereunder.
Negative Certification
I certify that all chemicals in this shipment are not subject to TSCA.

Product Number Product Name Product Description

Company name:___________________________________________________(optional)

Company address:_________________________________________________(optional)

Certifier name: ____________________________________________________

Certifier title: ____________________________________________________(optional)

Certifier phone number: ___________________________________________________

Certifier email address: ____________________________________________________

Certifier signature: ________________________________________________________

If the certifier is unsure if their chemical substance is subject to TSCA compliance, contact the Environmental Protection
Agency, TSCA Assistance Office at 1.202.554.1404 between 8:30 a.m. and 5:00 p.m .

09/2019