FORM-1721.A
FORM-1721.A
MABROOK HOTEL SUPPLIES COMPANY Ship goods via: Airfreight Sea freight
STREET NO.21, SHUWAIKH INDUSTRIAL AREA
Service level: Direct Consolidated
HA 32053, AL-JAHARA KUWAIT
4b. INTERMEDIATE CONSIGNEE (Complete name and address)
Insurance required: Yes $___________ No
Rapidex USA LLC DBA Compass Logistics International Documents required: Cert. of Origin Fumigation
71 Veronica Ave, Suite # 2
Somerset, NJ 08873 Authentication Legalization
5b. FORWARDING AGENT’S EIN (IRS) NO. 6. POINT OF ORIGIN (STATE) OR FTZ NO. 7. COUNTRY OF ULTIMATE DESTINATION
PO#EQ142836
10. EXPORTING CARRIER 11. PORT OF EXPORT 16. ENTRY NUMBER 17. HAZARDOUS MATERIALS
Yes No
12. PORT OF UNLADING (Vessel and Air only) 13. CONTAINERIZED (Vessel only) 18. IN BOND NUMBER 19. ROUTED EXPORT TRANSACTION
Yes No Yes No
20. SCHEDULE B DESCRIPTION OF COMMODITIES (Use Columns 22-24)
D/F or SCHEDULE B NUMBER QUANTITY SHIPPING VIN / PRODUCT NUMBER / VALUE EXPORT EXPORT
M SCHEDULE B WEIGHT VEHICLE TITLE NUMBER (US Dollars, omit LICENSE / CONTROL NO.
UNIT(S) (Kilograms) cents) PERMIT NO. (ECCN)
(21) (22) (23) (24) (25) (26) (27) (28)
These commodities, technology, or software were exported from the United States in accordance with the Export Administration Regulations. Diversion contrary to U.S. Law prohibited.
27. LICENSE NO. / LICENSE EXCEPTION SYMBOL / AUTHORIZATION 28. ECCN (When required) We have forwarded the above cargo to you:
NLR EAR99
Trucking company: __________________________
29. DULY AUTHORIZED OFFICER OR EMPLOYEE The USPPI authorizes the forwarder named above to act as
forwarding agent for export control and customs purposes.
LISA A ELKINS Tracking/PRO# : ____________________________
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, as set forth in the “Correct way to fill out the Shipper’s Export Declaration”. I understand that civil ETD: _______________ ETA: ________________
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 Confidential- For use solely for official purposes Please pickup Cargo at our location below:
authorized by the Secretary of Commerce (13 U.S.C.
310(g)
Company: _________________________________
Title Export shipments are subject to inspection by U.S.
Customs Service and/or office of Export Enforcement Address: __________________________________
SHIPPING
Date 31. AUTHENTICATION (When required) Address: __________________________________
MAR. 07, 2016
Hours: ______________ Tel: _________________
Telephone No. (Include Area Code) E-mail address
1(b) USPPI Employer Identification Number (EIN) or ID Number- Enter the USPPI’s Internal Revenue Service Employer Identification Number (EIN) or
Social Security Number (SSN) if no EIN has been assigned. Report the 9-digit numerical code as reported on your latest Employer's Quarterly Federal Tax
Return, Treasury Form 941. The EIN is usually available from your accounting or payroll department. If an EIN or SSN is not available a border crossing
number, passport number, or a Customs identification number must be reported. (See §30.7(d) (2))
1(c) Parties To Transaction - Indicate if this is a related or non-related party transaction. A related party transaction is a transaction between a USPPI and a
foreign consignee, (e.g., parent company or sister company), where there is at least 10 percent ownership of each by the same U.S. or foreign person or
business enterprise.
2 Date of Exportation - Enter the date the merchandise is scheduled to leave the United States for all methods of transportation . If the actual date is not
known, report the best estimate of departure. The date format should be indicated by MM/DD/YYYY.
3 Transportation Reference Number - Report the booking number for ocean shipments. The booking number is the reservation number assigned by the
carrier to hold space on the vessel for the cargo being shipped. For air shipments the air waybill number must be reported. For other methods of
transportation leave blank.
4(a) Ultimate Consignee - Enter the name and address of the foreign party actually receiving the merchandise for the designated end-use or the party so
designated on the export license. For overland shipments to Mexico, also include the Mexican state in the address.
4(b) Intermediate Consignee - Enter the name and address of the party in a foreign country who makes delivery of the merchandise to the ultimate consignee or
the party so named on the export license.
5 Forwarding Agent - Enter the name and address of the forwarding or other agent authorized by a principal party in interest.
5(b) Forwarding Agent Employer Identification Number (EIN) or ID Number - Enter the forwarding agent’s Internal Revenue Service Employer
Identification Number (EIN). Report the 9-digit numerical code as reported on the latest Employer’s Quarterly Federal Tax Return, Treasury Form 941. The
EIN is usually available from your accounting or payroll department.
6 Point (State) of Origin or Foreign Trade Zone (FTZ) Number (a) If from a FTZ enter the FTZ number for exports leaving the FTZ, otherwise enter the:
(b) two-digit U.S. Postal Service abbreviation of the state in which the merchandise actually starts its journey to the port of export, or (c) State of the
commodity of the greatest value, or (d) State of consolidation.
7 Country of Ultimate Destination - Enter the country in which the merchandise is to be consumed, further processed, or manufactured; the final country of
destination as known to the exporter at the time of shipment; or the country of ultimate destination as shown on the export license. Two-digit (alpha
character) International Standards Organization (ISO) codes may also be used.
8 Loading Pier - (For vessel shipments only) enter the number or name of the pier at which the merchandise is laden aboard the exporting vessel.
9 Method of Transportation - Enter the method of transportation by which the merchandise is exported (or exits the border of the United States). Specify the
method of transportation by name, such as, vessel, air, rail, truck, etc. Specify "own power" if applicable.
10 Exporting Carrier - Enter the name of the carrier transporting the merchandise out of the United States. For vessel shipments, give the name of the vessel.
11 Port of Export (a) For Overland Shipments - Enter the name of the U.S. Customs port at which the surface carrier (truck or railcar) crosses the border.
(b) For Vessel and Air Shipments - Enter the name of the U.S. Customs port where the merchandise is loaded on the carrier (airplane or ocean vessel) that is
taking the merchandise out of the United States. (c) For Postal (mail) Shipments - Enter the U.S. Post Office from which the merchandise is mailed.
12 Foreign Port of Unloading - For vessel shipments between the United States and foreign countries, enter the foreign port and country at which the
merchandise will be unloaded from the exporting carrier. For vessel and air shipments between the United States and Puerto Rico, enter the Schedule C code,
“U.S. Customs District and Port Code”.
13 Containerized - (For vessel shipments only) check the YES box for cargo originally booked as containerized cargo and for cargo that has been placed in
containers at the vessel operator's option.
14 Carrier Identification Code - Enter the 4-character Standard Carrier Alpha Code (SCAC) of the carrier for vessel, rail and truck shipments, or the 2- or 3-
character International Air Transport Association (IATA) Code of the carrier for air shipments. In a consolidated shipment, if the ultimate carrier is unknown,
the consolidator’s carrier ID code may be reported. The National Motor Freight Traffic Association (703) 838-1831 or www.nmfta.org issues the SCAC's for
ocean carriers, trucking companies and consolidators. The American Association of Railroads, Railinc (919) 651-5006 issues the SCAC codes for rail
carriers. The International Air Transportation Association (IATA) issues the air carrier codes. The IATA codes are available on the Foreign Trade Division
web site under “Air Carrier Codes” at <www.census.gov/foreign-trade>.
15 Shipment Reference Number - Enter the unique reference number assigned by the filer of the SED for identification purposes. This shipment reference
number must be unique for five years. For example, report an invoice number, bill of lading or air waybill number, internal file number or so forth.
Correct Way to Fill out the Shipper’s Export Declaration
16 Entry Number - Enter the Import Entry Number when the export transaction is used as proof of export for import transactions, such as In-Bond, Temporary
Import Bond or Drawback’s and so forth. Also, an Entry Number is required for merchandise that is entered as an import (CF 7501 or Automated Broker
Interface (ABI) entries) and is then being exported out of the United States.
17 Hazardous Materials - Check the appropriate “Yes” or “No” indicator that identifies the shipment as hazardous as defined by the Department of
Transportation.
18 In Bond Code - Report one of the 2 - character In-Bond Codes listed in Part IV of Appendix C of the FTSR (15 CFR Part 30) to indicate whether the
shipment is being transported under bond.
19 Routed Export Transaction - Check the appropriate “Yes” or “No” indicator that identifies the transaction as a routed export transaction. A routed export
transaction is where the foreign principal party in interest authorizes a U.S. forwarding or other agent to export the merchandise out of the United States.
20 Schedule B Description of Commodities - Use columns 22 - 24 to enter the commercial description of the commodity being exported, its schedule B
number, the quantity in schedule B units, and the shipping weight in kilograms. Enter a sufficient description of the commodity as to permit verification of
the Schedule B Commodity Number or the commodity description as shown on the validated export license. Include marks, numbers, or other identification
shown on the packages and the numbers and kinds of packages (boxes, barrels, baskets, etc.)
22 Schedule B Number - Enter the commercial description of the commodity being exported and the ten-digit commodity number as provided in Schedule B –
Statistical Classification of Domestic and Foreign Commodities Exported from the United States. See item 5 (page 2) for a discussion of not repeating the
same Schedule B numbers on the SED. If necessary, the Harmonized Tariff Schedule (HTS) number can be reported on the SED.
23 Quantity (Schedule B Units) - Report whole unit(s) as specified in the Schedule B commodity classification code. Report also the unit specified on the
export license if the units differ. See the Appendix showing a list of telephone numbers for assistance with units of quantity.
24 Shipping Weight (kilograms) - (For all methods of transportation) Enter the gross shipping weight in kilograms for each Schedule B number, including the
weight of containers but excluding carrier equipment. To determine kilograms use pounds (lbs) Multiplied by 0.4536 = kilograms (report whole units.)
25 VIN/Product Number/Vehicle Title Number - (For used self-propelled vehicles only). Report the following items of information for used self-propelled
vehicles as defined in Customs regulations 19 CFR 192.1: (1) Report the unique Vehicle Identification Number (VIN) in the proper format; (2) Report the
Product Identification Number (PIN) for those used self propelled vehicles for which there are no VINs; and (3) the Vehicle Title 13 Number.
26 Value (U.S. dollars) - Enter the selling price or cost if not sold, including freight, insurance, and other charges to U.S. port of export, but excluding
unconditional discounts and commissions (nearest whole dollar, omit cents). The value to be reported on the SED is the USPPI’s price or cost if not sold, to
the foreign principal party in interest. Report one value for each Schedule B number.
28 Export Control Classification Number (ECCN) - Whenever SED or AES record is required, you must enter the correct Export Control Classification
Number (ECCN) on the SED or AES record for all exports authorized under a license or License Exception, and items being exported under the “No License
Required” (NLR) provisions of the EAR that are listed on the CCL and have a reason for control other than anti-terrorism (AT).
29 Duly authorized officer or employee - Provide the signature of the USPPI authorizing the named forwarding or agent to effect the export when such agent
does not have a formal power of attorney or written authorization.
30 Signature/Certification - Provide the signature of the USPPI or authorized forwarding or other agent certifying the truth and accuracy of the information on
the SED, the title of USPPI or authorized agent, the date of signature, the telephone number of the USPPI or authorized agent preparing the SED and who
can best answer questions for resolving problems on the SED, and the email address of the USPPI or authorized agent.