Children's Product Certificate

Certificate ID: Version / date issued:

1. Product covered (§ 1110.11(a)(1))

Product description (enough detail to match the certificate to the product)

GTIN / UPC

Model / SKU / item number

Serial, lot or batch numbers (if any)

Registered or alternate ID (if any)

2. Safety rules this product is certified to (§ 1110.11(a)(2): list each separately)

Rule, ban, standard or regulation (citation)	Laboratory that tested it (see section 6)	Most recent test date	Testing exclusion / exemption, if any

3. Certifier: importer or domestic manufacturer (§ 1110.11(a)(3))

Name

Street address, city, state/province, country

Phone

4. Contact for test records (§ 1110.11(a)(4))

Name (a position title is fine if the position is always staffed)

Street address, city, state/province, country

Phone

Optional: web address where test records can be viewed (§ 1110.11(b))

5. Manufacture (§ 1110.11(a)(5))

Date of manufacture (at least month and year; first date of the production run)

Manufacturer name

Manufacturer street address, city, state/province, country (where the finished product was made)

Manufacturer email

Manufacturer phone

6. Testing (§ 1110.11(a)(6) and (c))

For a CPC, each lab must be a CPSC-accepted third-party lab. List each lab once and reference it in section 2. If a testing exclusion applies, name it in section 2 instead of a test date and place.

Lab	Lab or testing party name	Street address, city, state/province, country	Email	Phone	CPSC lab ID (CPC)
Lab A
Lab B

Place of testing, if different from the lab address

Small batch manufacturer registration number, if relying on small batch status (CPC only)

7. Attestation (§ 1110.11(a)(7))

I hereby certify that the finished product(s) covered by this certificate comply with the rules, bans, standards, and regulations stated herein, and that the information in this certificate is true and accurate to the best of my knowledge, information, and belief. I understand and acknowledge that it is a United States federal crime to knowingly and willfully make any materially false, fictitious, or fraudulent statement, representation, or omission on this certificate.

Name and title (optional; a signature is not required)

Date

Template prepared by CertFinch from 16 CFR part 1110 as revised (90 FR 1800, Jan. 8, 2025; in effect July 8, 2026). It must be in English (§ 1110.9) and describe only one product (§ 1110.13). Imported products: the certificate data must also be eFiled at entry. U.S.-made products: issue it by the time you distribute the product, give it to your distributors and retailers, and be ready to provide it to CPSC within 24 hours. This is a fill-in form, not legal advice. CertFinch is not affiliated with CPSC.