DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection APPLICATION FOR ALLOWANCE IN DUTIES
19 CFR 158.11, 158.13, 158.23
1. TO: (Port Director of CBP) 2. FROM: (Name and address of Importer or Agent)
OMB No. 1651-0007 Exp. 01-31-2010
3. ENTRY NO.
4. DATE
5. APPLICATION FOR ALLOWANCE IN DUTY BECAUSE OF: A. B. C. Damage Destruction (Casualty) Lost or stolen while in Public Excessive moisture and impurities not usually found in or upon such or similar merchandise. (Landed weight or gauge in excess of that invoiced is in itself not adequate evidence of excessive moisture or impurities.) Nonimportation of perishable merchandise. Goods to be segregated on pier at our place of business
Complete columns 6, 7, 8, and 9 for Claims A and B, and columns 8 and 9 for Claim C. INSTRUCTIONS: Columns 6 and 7 are self-explanatory. For column 8, the nature and normal content may be stated together, such as "2% moisture," or "No Sand," etc. When normal content is based upon a standard which the applicant contends is recognized and required by traders in a particular commodity, state the approximate length of time such standard has existed. For column 9, furnish results of laboratory test or other physical data obtained In support of this claim. 6. MARKS AND NUMBERS 7. DESCRIPTION OF MERCHANDISE 8. DESCRIBE CASUALTY, NATURE OF IMPURITY AND NORMAL CONTENT CONTENDED 9. LAB TEST RESULTS (Attach Copy)
10. IMPORTER 13. DATE, TIME, AND PLACE OF UNLOADING
11. OWNER/IMPORTER NUMBER
12. CARRIER
14. COMPLETE APPLICABLE STATEMENT BELOW (Letters match those above) I have personally inspected and examined the merchandise described and I hereby declare that same sustained damage above stated. A. The merchandise, to the best of my knowledge and belief, was Lost or stolen while in Public Stores Destroyed (Casualty) B. I have personally inspected and examined the merchandise described in the foregoing application and determine that the same contains excessive moisture, or other impurities, not usually found in or upon such or similar merchandise, as indicated above. This claim is based upon the following facts, if any, ascertained by me or under my direction.
C.
We request permission to segregate the damaged goods with the aggreement that all expenses in connection with the delivery under custody and the supervision of segregation at our place of business will be borne by us, and will be paid promptly. 16. SIGNATURE AND TITLE OF APPLICANT/AGENT
15. DATE OF FILING
17. CBP ACTION
18. DATE 19. SIGNATURE AND TITLE OF CBP OFFICER NOT ACCEPTED ACCEPTED PAPERWORK REDUCTION ACT: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out the laws and regulations administered by the Customs and Border Protection. The form is used by United States importers to apply for a duty allowance due to damaged or defective imported merchandise and by CBP to authorize such a duty allowance. It is required to obtain or retain a benefit. The estimated average burden associated with this collection of information is 8 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0007), Washington, DC 20503.
CBP Form 4315 (09/98)
CBP USE ONLY (Complete applicable parts)
Section 158.23, C.R. Merchandise Examined
(A) CLAIMS
DESCRIPTION OF DAMAGE SUSTAINED
Section 158.13, C.R. NATURE OF IMPURITY ON WHICH CLAIM IS BASED Contains Does not contain
(B) CLAIMS
impurities in excess of that usually found in or upon such or similar merchandise. 3. (A) Rate of damage or report as to loss or theft, or (B) Percentage of excessive impurities
COMPLETE ITEMS (1), (2), AND (3) 1. MARKS AND NUMBERS 2. DESCRIPTION OF MERCHANDISE
(If more space needed use separate sheet)
DATE OF REPORT
SIGNATURE AND TITLE OF CBP OFFICIAL
Section 158.11, C. R. (C) CLAIMS Authorization is granted for the importer to segregate from the remainder of the shipment and repack under supervision on pier DATE at his/her place of business that portion which arrived in bad condition.
SIGNATURE AND TITLE OF CBP OFFICIAL
The segregation and repacking was accomplished under continuous supervision, the segregated portion, consisting of both merchandise and empty containers, was disposed of by: DISPOSAL DATE NUMBER OF CRATES, BOXES, ETC. MANNER OF DESTRUCTION
DATE
SIGNATURE AND TITLE OF CBP OFFICIAL
The contents of the merchandise totaled below were found to be entirely without commercial value and were presumptively without value at time of arrival. DATE OF EXAMINATION NUMBER OF CRATES, BOXES, ETC.
DATE
SIGNATURE AND TITLE OF CBP OFFICIAL
CBP Form 4315 (09/98)(Back)