Power Of Attorney -U.s. Customs And Border Protection Page 2
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1
2INDIVIDUAL OR PARTNERSHIP CERTIFICATION
*
(Optional)
CITY
}
COUNTY
ss:
STATE
On this
day of
, 20
, personally appeared before me
residing at
, personally known or sufficiently identified to me, who certifies
(is)(are) the individual(s) who executed the
that
foregoing instrument and acknowledged it to be
free act and deed.
(Notary Public)
CORPORATE CERTIFICATION *
(Optional)
(To be made by an officer other than the one who executes the power of attorney)
I,
, certify that I am the
of
organized under the laws of the State of
that
, who
signed this power of attorney on behalf of the donor, is the
of said
corporation; and that said power of attorney was duly signed, sealed, and attested for and on behalf of said corporation by
authority of its governing body as the same appears in a resolution of the Board of Directors passed at a regular meeting
held on the
day of
, now in my possession or custody. I further certify that the
resolution is in accordance with the articles of incorporation and bylaws of said corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said corporation, at the City of
this
day of
, 20
(Signature)
(Date)
If the corporation has no corporate seal, the fact shall be stated, in which case a scroll or adhesive shall appear in the appropriate,
designated place.
U.S. Customs and Border Protection powers of attorney of residents (including resident corporations) shall be without power of
substitution except for the purpose of executing shipper's export declaration. However, a power of attorney executed in a favor of a
licensed customhouse broker may specify that he power of attorney is granted to the customhouse broker to act through any of its
licensed officers or any employee specifically authorized to act for such customhouse broker by power of attorney.
NOTE: The corporate seal may be omitted. CBP does not require completion of a certification. The grantor has the option of executing
the certification or omitting it.
CBP Form 5291 (09/08)
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