Fillable Printable Shipper's Export Declaration - United States

Shipper's Export Declaration - United States

FORM7525-V(7-18-2003)

OMB No. 0607-0152

U.S. DEPARTMENT OF COMMERCE – Economics and Statistics Administration – U.S. CENSUS BUREAU – BUREAU OF EXPORT ADMINISTRATION

SHIPPER’S EXPORT DECLARATION

1a. U.S. PRINCIPAL PARTY IN INTEREST (USPPI)(Complete name and address)

b. USPPI’S EIN (IRS) OR ID NO. c. PARTIES TO TRANSACTION

4a. ULTIMATE CONSIGNEE

b. INTERMEDIATE CONSIGNEE

5a. FORWARDING AGENT (Complete name and address)

8. LOADING PIER (Vessel only)

10. EXPORTING CARRIER

12. PORT OF UNLOADING (Vessel and air only)

9. METHOD OF TRANSPORTATION (Specify)

11. PORT OF EXPORT

13. CONTAINERIZED (Vessel only)

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.

16. ENTRY NUMBER 17. HAZARDOUS MATERIALS

18. IN BOND CODE 19. ROUTED EXPORT TRANSACTION

Related Non-related

Yes No Yes No

Yes No

20. SCHEDULE B DESCRIPTION OF COMMODITIES (Use columns 22–24)

(21) (22) (23) (24)

D/F

or M

SCHEDULE B NUMBER

QUANTITY –

SCHEDULE B UNIT(S)

SHIPPING WEIGHT

(Kilograms)

(25)

VIN/PRODUCT NUMBER/

VEHICLE TITLE NUMBER

(26)

VALUE (U.S. dollars,

omit cents)

(Selling price or cost if not

sold)

27. LICENSE NO./LICENSE EXCEPTION SYMBOL/AUTHORIZATION 28. ECCN (When required)

29. Duly authorized officer or employee

The USPPI authorizes the forwarder named above to

act as forwarding agent for export control and

customs purposes.

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).

30.

Signature

Title

Date

Telephone No. (Include Area Code)

31. AUTHENTICATION (When required)

E-mail address

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)).

Export shipments are subject to inspection by U.S. Customs Service

and/or Office of Export Enforcement.

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.

(Complete name and address)

5b. FORWARDING AGENT’S EIN (IRS) NO.

ZIP CODE