Download FRM-024 (Shipper Importer Declaration 9801.00.10)

FOREIGN SHIPPER / OWNER, IMPORTER, CONSIGNEE DECLARATIONS
FOR U.S. GOODS RETURNED (US ARTICLES EXPORTED AND REIMPORTED)
CLAIMED UNDER SUBHEADING 9801.00.10 VALUED OVER $2000 USD
In accordance with 19 CFR §10.1 for entry of articles claimed under subheading 9801.00.10
FOREIGN SHIPPER
Entry No. __________________________
I, _____________________________________________ (person making declaration) declare that to
the best of my knowledge and belief the articles herein specified were exported from the United
States, from the Port of ____________________ on or about _________________ (Date of
exportation),
and that they are returned without having been advanced in value or improved in
condition by any process of manufacture or other means.
Date__________________________Signature________________________________________
Address_____________________________________________Title______________________
Items
Quantity
Complete Description
Value
(*Include attachment if more article are declared)
OWNER, IMPORTER, CONSIGEE
I, ___________________________________ (person making declaration) declare that the above
declaration by the foreign shipper is true and correct to the best of my knowledge and belief, that
the articles were manufactured by ____________________________________________ (name of
the manufacturer)
located in ____________________________________ (city and state), that the
articles were not manufactured or produced in the United States under subheading 9813.00.05,
HTSUS, and that the articles were exported from the United States without benefit of drawback.
Date__________________________Signature________________________________________
Address_____________________________________________Title______________________
FOREIGN SHIPPER / OWNER, IMPORTER, CONSIGNEE DECLARATIONS | FRM-024
FOREIGN SHIPPER / OWNER, IMPORTER, CONSIGNEE DECLARATIONS
FOR U.S. GOODS RETURNED (US ARTICLES EXPORTED AND REIMPORTED)
CLAIMED UNDER SUBHEADING 9801.00.10 VALUED OVER $2000 USD
Please include the following supplementary documentation: (1) Manufacturer’s Affidavit
*(Continued)
Marks
Quantity
Item & Complete Description
Value
FOREIGN SHIPPER / OWNER, IMPORTER, CONSIGNEE DECLARATIONS | FRM-024