Cbp Form 214 - Application For Foreign-Trade Zone Admission And / Or Status Designation
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1
2DEPARTMENT OF HOMELAND SECURITY
Approved OMB No. 1651-0029 Exp. 10/31/2018
U.S. Customs and Border Protection
CENSUS USE ONLY
1. ZONE NO. AND LOCATION (Address)
APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION
2. PORT CODE
19 CFR 146.22, 146.32, 146.35-146.37, 146.39-146.41, 146.44, 146.53, 146.66
3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER
4. EXPORT DATE
5. IMPORT DATE
6. ZONE ADMISSION NO.
7. U.S. PORT OF UNLADING
8. FOREIGN PORT OF LADING
9. BILL OF LADING/AWB NO.
10. INWARD M'FEST NO.
12. I.T. NO. AND DATE
11. INBOND CARRIER
13. I.T. FROM (Port)
14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT?
YES
NO
19.
18.
15.
20.
16.
17.
NO. OF PACKAGES
SEPARATE
QUANTITY
GROSS
DESCRIPTION OF MERCHANDISE
HTSUS NO.
AND COUNTRY
VALUE & AGGR
(HTSUS)
WEIGHT
OF ORIGIN CODE
CHGS.
21. HARBOR MAINTENANCE FEE (19 CFR 24.24)
22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above
merchandise is not prohibited entry in the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended,
and section 146.31, Customs Regulations.
23. I hereby apply for the status designation indicated:
NONPRIVILEGED FOREIGN
PRIVILEGED FOREIGN
ZONE RESTRICTED
DOMESTIC
(19 CFR 146.42)
(19 CFR 146.41)
(19 CFR 146.44)
(19 CFR 146.43)
24. APPLICANT FIRM NAME
25. BY (Signature)
26. TITLE
27. DATE
F.T.Z. AGREES TO RECEIVE
28. FOR THE F.T.Z. OPERATOR (Signature)
29. TITLE
30. DATE
MERCHANDISE INTO THE ZONE
Permission is hereby granted to
31. PORT DIRECTOR OF CBP: BY (Signature)
32. TITLE
33. DATE
PERMIT
transfer the above merchandise
into the Zone.
34. PORT DIRECTOR OF CBP: BY (Signature)
35. TITLE
36. DATE
The above merchandise has been
PERMIT
granted the requested status.
37. The goods described herein are authorized to be transferred:
without exception
except as noted below
PERMIT
TO
TRANSFER
38. CBP OFFICER AT STATION (Signature)
39. TITLE
40. STATION
41. DATE
42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature)
43. CARTMAN
44. CHL NO.
45. DATE
46. To the Port Director of CBP: The above merchandise was received at the Zone on the date shown except as noted below:
FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT
47. FOR THE FTZ OPERATOR (Signature)
48. TITLE
49. DATE
ZONE
(See page 2 for Paperwork Reduction Act Notice.)
Previous Editions are Obsolete
CBP Form 214 (10/15)
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