Fillable Printable Form Approved Omb No
Fillable Printable Form Approved Omb No
Form Approved Omb No
OMB Approved No. 1651-0027 Expires 04/30/2020
19. Entry Number
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
RECORD OF VESSEL
FOREIGN REPAIR OR EQUIPMENT PURCHASE
19 CFR 4.7, 4.14
1. Function of this document (Check one)
DECLARATION
(Complete items 1-17 and 20-26)
ENTRY
(Complete items 1-16 and 20-28; 19 if available)
2. Owner Name Address
Phone
3. Represented Locally By: Name Address Phone
20. Principal Name
Importer No.
Address
Phone No.
4. Vessel Name 5. IMO No. 6. Name of Master
21. Surety Name and Number
7. Last U.S. Departure Port 8. Last U.S. Departure Date
9. Foreign Port Arrived From 10. Voyage No. 11. U.S. Port of Arrival 12. Port Code 13. Arrival Date
22. Bond:
Single Transaction
Continuous Bond
No.
23. Bond Amt.
14.
Location (City and Country) and Sailing
Date from that Country
15.
Description of Work Performed Including Identification of
Materials/Equipment Purchased
16.
Cost in foreign Money
24.
Exchange
Rate
25.
Entered
U.S. cost
26.
Duty @ 50% Entered
Cost in U.S. Money
27. TOTAL AMOUNT DECLARED
ITEMS BELOW FOR DECLARATION ONLY, DO NOT USE FOR ENTRY
28. CERTIFICATION OF MASTER OR AUTHORIZED AGENT OF THE OWNER
17. CERTIFICATION OF MASTER
18. CBP USE ONLY
As Master of the said vessel, I hereby subscribe to the
declaration statement on the back of this document.
I have examined the vessel's log, which indicates:
The undeclared repairs or purchases which I have listed on the back of this
declaration; No undeclared repairs or purchases.
Vessel not boarded; Log not examined.
I hereby subscribe to the statement relative to an
entry on the back of this document.
Check one:
A. Full and Complete
B. Incomplete
17A. Signature 18A. Signature 28A. Signature
17B. Title 17C. Date 18B. Title 18C. Date 28B. Title 28C. Date
CBP Form 226 (12/16)
I. DECLARATION STATEMENT (Applicable to Item 17 on front of form.)
II. ENTRY STATEMENT (Applicable to item 28 on front of form.)
As master of the said vessel or authorized agent of the
owner of the vessel and to the best of my knowledge and
belief, I declare that (Place "X" in Box "A" or Box "B" in
item 28 on the front of the document):
A. If I have marked Box "A", this entry contains a
full and complete account, together with the cost, at
the places and times mentioned, of the equipment
(including the boats) purchased for, or the repair
parts or materials to be used, or the expenses of the
repairs made in a foreign country for the said vessel.
B. If I have marked Box "B", this entry contains an
incomplete account, together with an estimate of the
total cost of the equipment purchased for, or the
repair parts or materials to be used, or the expenses
of the repairs made in a foreign country, and it is
requested that the determination of duty for the entry
be suspended pending the furnishing of a complete
account of the items liable to duty.
I further declare that if at any time hereafter I discover
any error in the account now produced or receive any
information showing a different state of facts, I will
immediately make the same known to the port director of
CBP. I hereby stipulate that the estimated duties will be
deposited, or bond given therefore, before clearance is
granted except on vessels specially exempted by
regulations of the Secretary of the Treasury, and that all
increased duties that may accrue will be paid when
ascertained.
As master of the said vessel and to the best of my
knowledge and belief, I declare that the itemized list on
the front of this form is a true statement of the cost of the
equipment (including boats) purchased for, or the repair
parts or materials to be used, or the expenses of repairs
made outside the United States upon the said vessel and
that there were no such purchases or expenses outside
the United States except as stated. I further declare that I
will immediately furnish to the appropriate CBP Officer
any information which hereafter comes to my attention
which indicates that the costs shown on the itemized list
are incorrect or that there are costs which are not
itemized. The statement does not include compensation
paid to members of the regular crew
1
in connection with
the installation of any such equipment or making of
repairs outside the United States. I have listed below any
items that I believe are clearly within the purview of
19 U.S.C. 1466(d)(3), such as dunnage,packing, or
temporary devices for the control of cargo.
I understand that except as provided in
section 4. 14(c), Customs Regulations, the vessel will not
be allowed to clear until estimated duties are deposited
or a bond on CBP Form 301 is given therefore, and that
the vessel is subject to forfeiture if the required report of
purchases and expenses is not made.
I declare that if no items are listed, then no such
equipment or repairs were purchased.
If my vessel is of more than 500 gross tons, I
declare that no work in the nature of an alteration or
rebuilding within the meaning of 46 U.S.C. 12139 and
12151 has been effected in any foreign port or place
which as not been separately reported. A copy of any
such report is attached. I understand that if a report of
such work is not made, the vessel is subject to seizure
by and forfeiture to the Government and the owner and I
are subject to a penalty of not more than $10,000. Each
day of a continuing violation is a separate violation.
1
Crewmembers signed on a vessel solely for the
purpose of making repairs are not members of the
regular crew within the meaning of 19 U.S.C. 1466(a),
and compensation paid to such crewmembers must be
reported as foreign labor used in making repairs.
CBP USE ONLY
Items within purview of 19 U.S.C. 1466(d)(3) if any: Undeclared Repairs or Purchases
Paperwork Reduction Act Statement: 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 1651-0027. The estimated average time to complete this application is 2 hours.
Obligation to respond is required to obtain benefit. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, PRA Clearance Officer,
Office of Regulations and Rulings, 90 K Street, NE., Washington DC 20229.
While this form collects information from the public, and the PTA has determined that a Privacy Impact Assessment (PIA) and System of Records Notice (SORN) is required, the
information collected is more business sensitive, and PRIV has recommended that we append a Privacy Notice instead of a Privacy Act Statement.
CBP Form 226 (12/16)
