1a. U.S. Principal Party in Interest (USPPI) (Complete name and address) |
1b. USPPO EIN (IRS) NO. or ID NO. |
1c. Parties to Transaction Related Non-Related |
2. Date of Exportation
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3. Transportation Reference No.
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4a. Ultimate Consignee (Complete name and address)
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4b. Intermediate Consignee (Complete name and address)
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5a. Forwarding Agent (Complete name and address)
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5b. Forwarding Agent's EIN (IRS) No.
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6. Point of Origin or FTZ No.
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7. Country of Ultimate Destination
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8. Loading Pier (Vessel Only)
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9. Method of Transportation (Specify)
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14. Carrier Identification Code
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15. Shipment Reference No.
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10. Exporting Carrier
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11. Port of Export
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16. Entry Number
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17. Hazardous Materials Yes No |
12. Port of Unloading (Vessel and air only)
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13. Containerized (Vessel only) Yes No |
18. In Bond Number
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19. Routed Export Transaction Yes No |
20. Schedule B Description of Commodities (Use columns 22-24) |
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| D/F or M (21) |
Schedule B Number (22) |
Quantity Schedule B Unit(s) (23) |
Shipping Weight (Kilograms) (24) |
VIN/Product Number/Vehicle Title Number (25) |
Value (U.S. dollars, omit cents) (Selling price or cost if not sold) (26) |
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| These commodities, technology or software were exported from the United State in accordance with the export Administration Regulations, Diversion contrary to U.S. law prohibited. |
Important handling instruction Special handling required as indicated:
Frozen Goods Refrigerate Upon Arrival Time Sensitive Material Sensitive Electronic Equipment Do Not Consolidate, Single Only Hazardous Goods Banking
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27. License No./License Exception Symbol/Authorization
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28. ECCN (When required) |
29. Duly Authorized Officer or Employee
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The USPFI authorized the forwarder named above to act as forwarding agent for export control and customs purposes. |
30. I certify that all statements made and all information contained herin are true and correct and that I have read and understand the instructions for preparation of this document, set forth in the "Correct Ways to Fill Out the Shipper's Export Declaration." I understand that civil and criminal penalties, including forfeitrue and sale, may be imposed for making false or fraudulent statements herin, failing to provide the requested information or for violation of U.S. laws on exportation (13 U.S.C. Sec. 305; 22 U.S.C. Sec. 401; 18 U.S.C. Sec. 1001; 50 U.S.C. App. 2410). |
Signature
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Title
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Export shipments are subject to inspection by U.S. Customs Service and/or Office of Export Enforcement. |
Date
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Tel. #
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Email Address
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31. Authentication (when required)
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NOTE: The shipper or its Authorized Agent grants authority to Westward Global. In its name and on its behalf, to act as forwarding agents for export control and customs purposes, and to prepare, sign, and/or accept any documents required to forward this shipment in accordance with the terms, conditions and limitations contained in the contracts of carriage and/or tariffs of any other carriers employed in the transportation of this shipment. The shipper guarantees payment of all collect charges in the event the cosignee refuses payment. Hereinunder, the sole responsibility of Westward Global is to use reasonable care in the selection of carriers, fowarders, agents and others to whom it may entrust the shipment. |
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