Cbp Form 3495 - Application For Exportation Of Articles Under Special Bond

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Form Approved OMB No. 1651-0004

View Form 3495 Instructions

Exp. 08-31-2017

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

APPLICATION FOR EXPORTATION OF ARTICLES UNDER SPECIAL BOND

19 CFR 10.38

TO CBP PORT DIRECTOR

1. TO: CBP Port Director (Address)

2. FROM: (Name and Address of Importer or Agent)

ATTACH COPY OF EXPORT INVOICE DESCRIBING ARTICLES TO BE EXPORTED

3. Name of Exporting Carrier

4. Date of Departure

5. Country of Origin

6. No. of Export Packages

7. Port of Entry

8. Entry Number

Date

9. Date Bonded Period Expires

10. Date Articles Available for CBP Examination

11. Signature of Importer or Agent

12. Date

(FOR CBP USE ONLY)

NOTICE TO IMPORTER TO DELIVER ARTICLES TO BE EXAMINED AND IDENTIFIED FOR EXPORTATION

13. Place of CBP Examination

Date

14. Date

15. CBP PORT DIRECTOR

BY:

REPORT OF EXAMINATION

16. The articles covered by this application have been examined and agree with the invoice in content and No. of export pkgs. and are approved for export.

17. No. of Export Packages

18. Date of Delivery for Exportation

19. Marks and Numbers on Export Packages

20. The articles covered by this application do not agree with the invoice in content or in number of packages as follows

21. SIGNATURE OF EXAMINING CBP OFFICER

22. DATE

REPORT OF EXPORTATION

23. Home of Exporting Conveyance (Vessel, Railroad, Airline and Flight Number)

24. Date of Departure

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information

collection and a person is not required to respond to this information unless it displays a current

25. Manifest No.