Form Approved OMB No. 1651-0005 Exp. 01-31-2010
Container
Day Phone
From:
Signature of CBP Officer
Date/Time
No.
APPROVED
CBP USE ONLY
Night Phone
8. Locations (Dock/Terminal)*
5. Name/Phone No. of Agent
2. Port
4. Name and Nationality of Owner/Operator
3. Flag
1. Name of Vessel, Vehicle or Aircraft
10. Itinerary of Vessel/Aircraft (show port country and departure dates for entire voyage including U.S. itinerary)*
(5) Other
(4) To land and release for repair, adjustment, or refilling and to relade under CBP supervision articles of carrier's equipment. (Articles to
be listed reverse side hereof showing date and hour of unlading and relading.) The undersigned certifies the articles listed on the
reverse hereof for release under this term is to be landed only for the purpose mentioned in this item and will be reladen on this carrier.
(3) To lade merchandise or baggage requiring CBP supervision.
(1) To unlade merchandise (intended to be unladen at this port, as shown by the manifest), baggage or passengers. To discharge
ballast, and to land ''in bond'' merchandise. (Sec. 551, Tariff Act of 1930).
(2) To land supplies, ship's stores, sea stores, or equipment not to be reladen, subject, however, to free or duty-paid entry (Sec. 446,
Tariff Act of 1930).
12. List all carriers, including carriers sharing or chartering space onboard the vessel and check the box that describes how the carrier
presented the cargo manifest.*
11. TYPE OF CARGO:
23. Date
22. Signature
21. Address of Agent
19. Date of Bond
To:
18. Amount of Bond
15. Application is made for a Term Permit and Special License
20. Importer Number
(Party to be billed; show hyphens)
16. Principal on Bond
14. Bond No.
or
at
13. Application is made for a special license for overtime services of CBP officers and employees for:
17. Surety Company Code
SCAC
AMS
CBP 1302 Paperless
SCAC
CBP 1302 Paperless
AMS
9. Application is made for a permit for the operations indicated:
*use back for additional space; (Instructions and