Get CBP 4455 2019-2024

CERTIFICATE OF REGISTRATION 19 CFR 10. 8 10. 9 10. 68 148. 1 148. 8 148. 32 148. 37 NOTE Number of copies to be submitted varies with type of transaction. Inquire at Port Director s office as to number of copies required. B/L or INSURED NO. VIA Carrier DATE ARTICLES EXPORTED FOR NAME ADDRESS AND ZIP CODE TO WHICH CERTIFIED FORM IS TO BE MAILED If Applicable ALTERATION REPAIR USE ABROAD REPLACEMENT PROCESSING OTHER specify NOTE The cost or value of alterations repairs or processing abroad is subject to CBP duty. OMB Control Number 1651-0010 Expiration Date 08/31/2019 DEPARTMENT OF HOMELAND SECURITY U*S* Customs and Border Protection NO. CERTIFICATE OF REGISTRATION 19 CFR 10. 8 10. 9 10. 68 148. 1 148. 8 148. 32 148. 37 NOTE Number of copies to be submitted varies with type of transaction* Inquire at Port Director s office as to number of copies required* B/L or INSURED NO. VIA Carrier DATE ARTICLES EXPORTED FOR NAME ADDRESS AND ZIP CODE TO WHICH CERTIFIED FORM IS TO BE MAILED If Applicable ALTERATION REPAIR USE ABROAD REPLACEMENT PROCESSING OTHER specify NOTE The cost or value of alterations repairs or processing abroad is subject to CBP duty. LIST ARTICLES EXPORTED Number Packages Kind of Description SIGNATURE OF OWNER OR AGENT Print or Type and Sign The Above-Described Articles Were EXAMINED PORT SIGNATURE OF CBP OFFICER LADEN under my supervision Duty-free entry is claimed for the described articles as having been exported without benefit of drawback and are returned unchanged except as noted use reverse if needed NOTE Certifying officers shall draw lines through all unused spaces with ink or indelible pencil* Paperwork Reduction Act Notice An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0010. The estimated average time to complete this application is 10 minutes. If you have any comments regarding the burden estimate you can write to U*S* Customs and Border Protection Office of Regulations and Rulings 799 9th Street NW* Washington DC 20229. OMB Control Number 1651-0010 Expiration Date 08/31/2019 DEPARTMENT OF HOMELAND SECURITY U*S* Customs and Border Protection NO. CERTIFICATE OF REGISTRATION 19 CFR 10. 8 10. 9 10. 68 148. 1 148. 8 148. 32 148. 37 NOTE Number of copies to be submitted varies with type of transaction* Inquire at Port Director s office as to number of copies required* B/L or INSURED NO. VIA Carrier DATE ARTICLES EXPORTED FOR NAME ADDRESS AND ZIP CODE TO WHICH CERTIFIED FORM IS TO BE MAILED If Applicable ALTERATION REPAIR USE ABROAD REPLACEMENT PROCESSING OTHER specify NOTE The cost or value of alterations repairs or processing abroad is subject to CBP duty. LIST ARTICLES EXPORTED Number Packages Kind of Description SIGNATURE OF OWNER OR AGENT Print or Type and Sign The Above-Described Articles Were EXAMINED PORT SIGNATURE OF CBP OFFICER LADEN under my supervision Duty-free entry is claimed for the described articles as having been exported without benefit of drawback and are returned unchanged except as noted use reverse if needed NOTE Certifying officers shall draw lines through all unused spaces with ink or indelible pencil* Paperwork Reduction Act Notice An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date.