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Get Shipper's Export Declaration

U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU BUREAU OF EXPORT ADMINISTRATION FORM SHIPPER S EXPORT DECLARATION 7525-V 7-18-2003 OMB No. 0607-0152 1a. U.S. PRINCIPAL PARTY IN INTEREST USPPI Complete name and address ZIP CODE b. Date 31. AUTHENTICATION When required Telephone No. Include Area Code E-mail address Clear fields 1 to 19 Clear Fields 20 to 26 Clear all fields This form may be printed by private parties provided it conforms to the official form. For sale by the Superintendent of Documents Government Printing Office Washington DC 20402 and local Customs District Directors. The Correct Way to Fill Out the Shipper s Export Declaration is available from the U.S. Census Bureau Washington DC 20233. USPPI S EIN IRS OR ID NO. 2. DATE OF EXPORTATION 3. TRANSPORTATION REFERENCE NO. 6. POINT STATE OF ORIGIN OR FTZ NO. 7. COUNTRY OF ULTIMATE DESTINATION 14. CARRIER IDENTIFICATION CODE 15. SHIPMENT REFERENCE NO. c* PARTIES TO TRANSACTION Related Non-related 4a* ULTIMATE CONSIGNEE Complete name and address b. INTERMEDIATE CONSIGNEE Complete name and address 5a* FORWARDING AGENT Complete name and address 8. LOADING PIER Vessel only 9. METHOD OF TRANSPORTATION Specify 10. EXPORTING CARRIER 11. PORT OF EXPORT 16. ENTRY NUMBER 17. HAZARDOUS MATERIALS 12. PORT OF UNLOADING Vessel and air only 13. CONTAINERIZED Vessel only 18. IN BOND CODE 19. ROUTED EXPORT TRANSACTION Yes No 20. SCHEDULE B DESCRIPTION OF COMMODITIES Use columns 22 24 D/F or M SCHEDULE B NUMBER QUANTITY SCHEDULE B UNIT S SHIPPING WEIGHT Kilograms 27. LICENSE NO. /LICENSE EXCEPTION SYMBOL/AUTHORIZATION 29. Duly authorized officer or employee VIN/PRODUCT NUMBER/ VEHICLE TITLE NUMBER VALUE U*S* dollars omit cents Selling price or cost if not sold 28. ECCN When required The USPPI authorizes 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 herein are true and correct and that I have read and understand the instructions for preparation of this document set forth in the Correct Way to Fill Out the Shipper s Export Declaration* I understand that civil and criminal penalties including forfeiture and sale may be imposed for making false or fraudulent statements herein 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 Confidential Shipper s Export Declarations or any successor document wherever located shall be exempt from public disclosure unless the Secretary determines that such exemption would be contrary to the national interest Title 13 Chapter 9 Section 301 g. Title Export shipments are subject to inspection by U*S* Customs Service and/or Office of Export Enforcement. Date 31. AUTHENTICATION When required Telephone No* Include Area Code E-mail address Clear fields 1 to 19 Clear Fields 20 to 26 Clear all fields This form may be printed by private parties provided it conforms to the official form* For sale by the Superintendent of Documents Government Printing Office Washington DC 20402 and local Customs District Directors.

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