1a.U.S. PRINCIPAL PARTY IN INTEREST (USPPI)
(Complete name and address)
2. DATE OF EXPORTATION 3. TRANSPORTATION REFERENCE NO.
6. POINT (STATE) OF ORIGIN OR FTZ NO. 7. COUNTRY OF ULTIMATE DESTINATION
16. ENTRY NUMBER 17. HAZARDOUS MATERIALS
Yes No
18. IN BOND CODE 19. ROUTED EXPORT TRANSACTION
Yes No
8. LOADING PIER
(Vessel only)
9. METHOD OF TRANSPORTATION
(Specify)
10. EXPORTING CARRIER 11. PORT OF EXPORT
12. PORT OF UNLOADING
(Vessel and air only)
12. CONTAINERIZED
(Vessel only)
Yes No
20. SCHEDULE B DESCRIPTION OF COMMODITIES
(Use columns 22-24)
5. FORWARDING AGENT
(Complete name and address)
ZIP CODE
b. USPPI EIN (IRS) OR ID NO. c. PARTIES TO TRANSACTION
Related Non-related
4a.ULTIMATE CONSIGNEE
(Complete name and address)
b. INTERMEDIATE CONSIGNEE
(Complete name and address)
14. CARRIER IDENTIFICATION CODE 15. SHIPMENT REFERENCE NO.
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.
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
Title
Date 31.
AUTHENTICATION
(When required)
Telephone No.
(Include Area Code)
E-mail address
U.S. DEPARTMENT OF COMMERCE — U.S. CENSUS BUREAU – Economics and Statistics Administration — BUREAU OF EXPORT ADMINISTRATION
SHIPPER’S EXPORT DECLARATION
OMB NO. 0607-0152
D/F
or M
(21)
SCHEDULE B NUMBER
(22)
QUANTITY
SCHEDULE B UNIT(S)
(23)
SHIPPING WEIGHT
(Kilograms)
(24)
VIN/PRODUCT NUMBER/
VEHICLE TITLE NUMBER
(25)
VALUE (U.S. dollars,
omit cents)
(Selling price or cost if not
sold)
(26)
Confidential - For use solely for official purposes authorized by the
Secretary of Commerce (13 U.S.C. 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.
FORM 7525-V (7-25-2000)
Vessel
X
