Cbp Form I-418 - Us Customs And Border Protection
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4DEPARTMENT OF HOMELAND SECURITY
OMB 1651-0103
Expires 08/31/2016
U.S. Customs and Border Protection
PASSENGER LIST - CREW LIST
Prior to arrival in the United States, complete a separate form for a) working crew; and b) passengers and supernumeraries. In addition to its initial completion, the crew list shall be updated to reflect crew
changes and other relevant activity (or lack thereof) until the vessel departs the United States.
Vessel Name:
Nationality:
Official Number:
Last Foreign Port (Place and Country):
Date Sailed from Foreign Port:
Date of Arrival in U.S.:
Arrival Port:
No. of Crew (including Master):
No. of Passengers:
Agent at Arrival (Name & Address):
Will crew perform longshore work while vessel is in the United States?
NO
YES
(Provide applicable INA Section 258 Exemption):
PROPOSED ITINERARY
Next U.S. Port(s)
Arrival Date
Vessel Agent (Name and Address)
PASSENGER LIST
CREW LIST
Page 1 of
List individuals alphabetically. Crew who join the vessel subsequent to its arrival while in the United States must be added to the original list and the appropriate date recorded in the "Date Joined" column.
The "Date Separated" column must be used when a listed crewman is separated from the vessel while it is in the United States. Any crewman designated as "REFUSED" in the "DHS Use Only" column is to
be detained on the vessel at all times.
Inspection Status
Date
Date
Date of
Nationality/
Position or Title
(DHS Use Only)
Family Name
First Name & Initial
Joined
Separated
Birth
Document #
(Crew Only)
Checked box indicates
(Crew Only)
(Crew Only)
subsequent parole.
I-418 Receipt Number (POE - YYMMDD - Badge # - Military Time):
RECEIPT FOR CREW LIST (CBP Use Only). I-418 Receipt Number at right indicates that the U.S. Customs and Border Protection (CBP)
has received the CREW LIST containing the names of all members of crew, including Master, on board said vessel at time of its arrival.
CBP Port of Arrival (address):
SUMMARY OF DEPARTURE. Vessel Agent (at Departure): Following this vessel's departure from the United States, ensure that crew
Date of Departure:
Port of Departure:
list reflects all crew additions and separations and is promptly submitted to the U.S. Customs and Border Protection office at the port of
departure. Summarize the departure circumstances by providing the following information:
Total Added Crew:
Total Separated Crew:
Agent at Departure (Name & Address):
CBP Form I-418 (09/16)
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