DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
(Lading/Foreign Trade Zone Transfer)
19 CFR 191.92, 191.93, 191.163
1. FUNCTION OF DOCUMENT
2. Port Number
3. Port
4. Notice Number
5. Articles to be Laden/Transferred by (Name)
6. Location (Port and Place or City and State)
7. Destination or Zone Number
8. Vessel, Aircraft, or Zone Lot No.
9. Marks and Numbers
10. Number and Kind of Packages, Contents and Quantity
12. Port Where Drawback Entry to be Filed
13. Name of Manufacturer or Producer
11. Forward Executed Certificate to (Name and Address)
14. No. of Crew*
15. No. of Pass*
to a foreign-trade zone for the sole purpose of exportation, destruction
(except distilled spirits, wines, and fermented malt liquors), or storage and are not
to be returned to customs territory of the United States for domestic consumption.
To the best of my knowledge and belief said articles are unused and are entitled on lading or transfer to drawback of the duties paid on the imported materials
used in their manufacture, or of the internal revenue tax paid on the domestic materials used.
17. Exporter, Transferor or Agent Signature,
CUSTOMS CERTIFICATION
(Do not use when Blanket Certificate of Lading is completed on reverse hereof)
18. Vessel/Aircraft Registry or Foreign Trade Zone Number
19. Destination or Zone Lot Number
21.
FOREIGN TRADE ZONE TRANSFER: I certify that I have
inspected the packages bearing the marks and numbers as described in this notice
of transfer and find them to be as stated and that they were assigned the zone lot
number in Block 19.
LADING: The vessel (or vehicle or aircraft) specified herein was cleared (or
departed under permit).
20. Date Vessel or Aircraft was cleared (or departed under permit)
or Date Articles Received.
Signature
22. DECLARATION OF MASTER OR OTHER OFFICER
I declare that the information given above is true and correct to the best of my knowledge and belief; that I have knowledge of the facts set forth herein; that the articles described in this notice of lading were received in the quantities stated, from the person, and on the date, indicated above; that said articles were laden on the vessel (or aircraft) named above for use on said vessel (or aircraft) as supplies (or equipment), except as noted below; and that at the time of lading of the articles, the said vessel (or aircraft) was engaged in the business or trade checked below: (It is not necessary for a foreign vessel to show its class of trade.)
Foreign
Trade
23. Name of Foreign Trade Zone Operator or Airline
24. Articles Received From
25. Date Received or Laden
26. Name and title of Individual Receiving Articles
27. Signature
28. Exceptions
16. Duration of Voyage*
Title
Date
Title
Date
Foreign
Destination
By
Paperwork Reduction Act Notice We require this information to enforce the Customs laws of the United States. This form is used to record and
verify receipt and use of supplies in operating vessels or aircraft and to transfer articles manufactured or produced in the United States into a foreign trade zone. Your response is mandatory.
Type of
Fuel Laden
Date of
Lading
Date of
Clearance
Title