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U.S. DEPARTMENT OF COMMERCE - BUREAU OF THE CENSUS - INTERNATIONAL TRADE ADMINISTRATION

SHIPPER’S EXPORT DECLARATION

7525-V

FORM

(1-1-88)

OMB NO. 0607-0018

1a.EXPORTER (Name and address including ZIP code)

ZIP CODE

2.DATE OF EXPORTATION

3.BILL OF LADING/AIR WAYBILL NO.

b.EXPORTER EIN (IRS) NO

c.PARTIES TO TRANSACTION

Non-related

4a.ULTIMATE CONSIGNEE

b.INTERMEDIATE CONSIGNEE

5.FORWARDING AGENT

6.POINT (STATE) OF ORIGIN/FTZ NO.

7.COUNTRY OF ULTIMATE DESTINATION

8.LOADING PIER (Vessel only)

9.MODE OF TRANSPORT (Specify)

11.PORT OF EXPORT

10.EXPORTING CARRIER

13.CONTAINERIZED (Vessel only)

12.PORT OF UNLOADING

(Vessel/air only)

Yes

14.SCHEDULE B DESCRIPTION OF COMMODITIES

}

(Use columns 17-19)

VALUE (U.S. dollars,

15.MARKS, NOS., AND KINDS OF PACKAGES

omit cents)

(Selling Price or

QUANTITY-

SHIPPING WEIGHT

Cost if not sold)

D/F

SCHEDULE B NUMBER

CHECK

SCHEDULE B UNIT(S)

(Kilos)

(20)

( 1 6 )

(17)

DIGIT

(18)

(19)

21.VALIDATED LICENSE NO./GENERAL LICENSE SYMBOL

22.ECCN (When required)

23.Duly authorized officer or employee

The exporter authorizes the forwarder named

above to act as forwarding agent for export

control and customs purposes.

24.

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 (available Bureau of Census,

Wash. DC 20233). I understand that civil and criminal penalities, 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. 1001; 50 U.S.C. App. 2410)

Signature

Confidential-For use solely for offical purposes authorized

by the Secretary of Commerce (13 U.S.C. 301 (g))

Title

Export shipments are subject to inspection by US Customs

Service and or Office of Export Enforcment.

Date

25.AUTHENTICATION (When required)

Export Declaration Form - Aim High, Inc. Home Page

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