DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
CORPORATE SURETY POWER OF ATTORNEY
1. THIS FORM MUST BE TYPED.
2. DO NOT ALTER THIS FORM.
3. ORIGINAL TO BE SUBMITTED
TO CBP. (See Option explained
in Instruction No. 2.)
OMB No. 1651-0050 Exp. 12/31/2010
CBP USE ONLY
DATE RECEIVED
EFFECTIVE DATE
In witness whereof, the said Grantor, by
virtue of authority conferred by its
Board of Directors, has caused these
presents to be sealed with its corporate
seal and attested by any two principal
officers.
GRANT
(Instruction
No. 3a.)
CHANGE to Grant on file
(Instruction No. 3b.)
GRANTEE:
GRANTOR:
REVOCATION. The below-described
powers previously granted are hereby
revoked. (Instruction No. 3c.)
ADDRESS
NAME
SOCIAL SECURITY NUMBER
SURETY COMPANY'S CORPORATE NAME
PORT
PORT
PORT
PORT
PORT
PORT
LIMIT
LIMIT
LIMIT
LIMIT
LIMIT
LIMIT
Port code(s) for CBP port(s) in which authorized to do business and limit on any single oblligation -OR- port(s) being added to the original grant.
CBP Form 5297 (06/08)
SURETY NO.
STATE UNDER WHOSE LAWS ORGANIZED AS A SURETY
Date Attested
Name and Title
Signature:
Name and Title
Signature:
Use a facsimile of corporate
seal, and not impression seal.
Grantor appoints the above-named person (Grantee) as its attorney in fact to sign its name as surety to, and to execute, seal, and acknowledge any bond so as to bind the
surety corporation to the same extent as if done by a regularly elected officer, limited only to the extent shown above as to Customs and Border Protection port and amount on
any single bond obligation. This grant, or change to a grant on file, or revocation, as specified, shall become active on the effective date shown provided the CBP Form 5297 is
received at a port office 5 days before the effective date shown; otherwise the specified actions will be come active at the close of business 5 working days after the date of
receipt at the port office.
This is an
address
change
This is
a name
change
Distribution: 3 copies
Explanations:
1. A Corporate Surety Power of