Cbp Form 442 - Application For Exemption From Special Landing Requirements (Overflight) Page 2

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PILOT/CREW INFORMATION (if additional space is needed, provide attachments)

13. Pilot/Crew Name & Address:

14. DOB

15. SEX

16. Citizenship

17. Passport

18. Social Security #

19. Pilot

(Use Full Legal Name)

(mm/dd/yyyy)

Place of Birth

and /or Doc #

(optional)

License #

USUAL OR ANTICIPATED PASSENGERS (if additional space is needed, provide attachments)

20. Name & Address: (Use Full Legal Name)

23. Citizenship

24. Passport and

25. Social Security #

21. DOB

22. SEX

Place of Birth

/or Doc #

(optional)

(mm/dd/yyyy)

USUAL OR ANTICIPATED CARGO (if additional space is needed, provide attachments)

26. List Usual Cargo or Baggage

SIGNATURE AND STATEMENT OF OWNER/APPLICANT

I hereby certify that all the information given on this application is true and complete, and I authorize U.S Customs and Border Protection to perform whatever

checks are necessary to verify my eligibility for, and compliance with 19 CFR 122. I acknowledge that I have read the rules of this program and agree to abide

by them. I understand that significant penalties may be incurred by my business and/or me personally for non-compliance.

To the best of your knowledge has anyone on this application ever been convicted of any Federal, State, Military or Foreign Crime or Offense other than

Traffic Violations in this country or elsewhere? (Violations that occurred prior to a person's 16th birthday may be excluded).

YES, Attach Explanation

This aircraft used with this Overflight Exemption (if approved) will be equipped with a Class "C'' Transponder. The aircraft will be operated above 12,500 feet

during normal flight conditions unless ordered to fly at a lower attitude by FAA flight controllers and IFR flight rules will apply when arriving from foreign ports.

The U.S. Customs and Border Protection Port of first intended landing will be notified in advance (24 hours or other local arrangements). The aircraft must be

available for inspection by CBP anytime. If the applicant has entered into a time-share or lease agreement with a particular aircraft, by signing below the

applicant agrees to having full operational control of the aircraft and all passengers, cargo, and crew that are being transported.

27. Owner Signature/ApplicantSignature

28. Date

29. Notary or CBP Officer's Signature (OVERFLIGHT)

30. Date

Mail Application to:

U.S. Customs and Border Protection

Attn: Overflight Desk

69 Terminal B

Newark IAP

Newark, NJ 07114

This application must be renewed every two (2) years (bi-annual) for the ''Term" Overflight program.