Form Cg-3300 Department Of Homeland Security - U.s. Coast Guard Application For Permit To Enter Cuban Territorial Seas

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DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard

APPLICATION FOR PERMIT TO ENTER

OMB Control Number: 1625-0106

CUBAN TERRITORIAL SEAS

Expiration Date: 08/31/2014

WARNING: This permit does not constitute license or permission from the United States to engage in any activity that may be contrary to applicable United

States laws or that of a foreign state. Your application requires an Office of Foreign Assets Control specific license to engage in travel related transactions

involving Cuba. In addition, your application must include a Department of Commerce export license for any vessel or conveyance entering Cuban territorial

seas. Failure to obtain all of the appropriate permits and licenses prior to travel to Cuba may result in felony prosecution, vessel seizure, and/or fines and

administrative penalties.

Vessel Owner/Operator Name

Date of Birth

Residence Address

City

State

Zip

Phone #

Fax #

E-mail

Current location of vessel - Latitude: __________N

Longitude: ___________W

and/or Marina name/location:

1. I am the (check all that apply):

Owner

Master

Person in Charge

Operator of:

Vessel Name: ___________________________________

Flag: ________________________ Type: __________________________________

Make/Model: ____________________________________

Navigation Equipment: __________________________________________________

Vessel Color: ____________________________________

Engine Type (Inboard/Outboard): __________________________________________

Registration #: ___________________________________

Length: _________

Homeport: _________________________________________

2. I request authorization to depart the U.S. territorial seas with the intent to enter the Cuban Territorial Sea during the voyage described below:

Last U.S. port prior to entering Cuban waters: __________________________________

Date of departure: _________________________

Intended Cuban destination port: ____________________________________________

Date of arrival: ____________________________

Approximate position of intended entry into Cuban waters: Latitude ________________ N

Longitude ______________________________ W

First U.S. port call after departing Cuban waters: ________________________________

Date of arrival: ____________________________

3. I acknowledge that nothing in this permit authorizes any violation of U.S. or foreign laws or regulations. (Detailed information on the U.S.

embargo can be obtained from the U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC) in Miami at 305 810-5140 & the

Department of Commerce (DOC) at 954 356-7540 or 202 482-4811.) I certify that all persons authorized to crew, operate, or assist operations

aboard my vessel, as listed below, have been made aware of the contents of this form, the regulations, and the U.S. embargo.

Name

Birthdate

Address

City

State

Zip

1. __________________________________

___________

_______________________

___________________

________

__________

2. __________________________________

___________

_______________________

___________________

________

__________

3. __________________________________

___________

_______________________

___________________

________

__________

4. __________________________________

___________

_______________________

___________________

________

__________

5. __________________________________

___________

_______________________

___________________

________

__________

Additional names/crew info listed on page 2 of this form.

4. Complete the following:

My purpose for the voyage is

___________________________________________________________________________________________________________________________

My OFAC license number for this voyage is _______________. (Or provide a written certification identifying the OFAC general license provision under

which you seek to engage in travel-related transactions and describing the activities you seek to engage in within the terms of that general license.)

My Commerce export license number for this voyage is _______________________________________________________________________________

Fax a copy of your approved OFAC and DOC export licenses with this application.

5. I understand that willfully making a false, fictitious, or fraudulent statement or concealing a material fact in this matter can result in a maximum

penalty of imprisonment for 5 years and a fine of $250,000 (18 USC 1001). I certify the above information I have supplied is true and correct.

Signature: _________________________________________________________________________________

Date: _____________________

Fax the completed form to the Seventh Coast Guard District at (305) 415-6809. Questions: (305) 415-6800

CG-3300 (3/11)

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