Application-Permit-Special License Unlading-Lading-Overtime Services printable pdf download

Form Approved OMB No. 1651-0005 Exp. 02-28-2013

DEPARTMENT OF HOMELAND SECURITY

CBP USE ONLY

U.S. Custons and Border Protection

APPROVED

APPLICATION-PERMIT-SPECIAL LICENSE

No.

UNLADING-LADING-OVERTIME SERVICES

Date/Time

Signature of CBP Officer

19 CFR 4.10, 4.30, 4.37, 4.39, 4.91, 10.60, 24.16,

122.29, 122.38, 123.8, 146.32, 146.34

1. Name of Vessel, Vehicle or Aircraft

2. Port

BW Jaguar

IMO:

9635858

Beaumont, Tx 2104

3. Flag

4. Name and Nationality of Owner/Operator

5. Name/Phone No. of Agent

Singapore

BW Sheko Pte. Ltd.

MORAN-GULF SHIPPING AGENCIES, INC.

Singapore

409-722-9393 (24 HRS)

Day Phone

6. Arriving from (Port Name and Country)

7. Date/Time of Arrival

8. Locations (Dock/Terminal)*

Cotonou, Benin

17-Aug-14

1900

ExxonMobil

Same as Day Phone

Night Phone

9. Application is made for a permit for the operations indicated:

(1) To unlade merchandise (intended to be unladen at this port, as shown by the manifest), baggage or passengers, To discharge ballast, and to land

"in bond" merchandise. (Sec. 551, Tariff Act of 1930).

(2) To land supplies, ship's stores, sea stores, or equipment not to be reladen, subject, however, to free or duty-paid entry (Sec. 446, Tariff Act of 1930).

(3) To lade merchandise or baggage requiring Customs supervision.

(4) To land and release for repair, adjustment, or refilling and to relade under Customs supervisions articles of carrier's equipment. (Articles to be

listed reverse side hereof showing date and hour of unlading and relading.) The undersigned certifies the articles listed on the reverse hereof

for release under this term is to be landed only for the purpose mentioned in this item and will be reladen on this carrier.

(5) Other

ICB INFO:

BW Sheko Pte. Ltd.

9911MX135

10. Itinerary of Vessel/Aircraft (show port country and departure dates for entire voyage including U.S. itinerary)*

Cotonou, Benin (13Jul) / Lome, Togo (07Jul)

TYPE OF CARGO:

11.

Container

Break Bulk

X Bulk

Other (Specify)

List all carriers, including carriers sharing or chartering space onboard the vessel and check the box that describes how the carrier presented the

12.

cargo manifest.*

SCAC

AMS

CF 1302

SCAC

AMS

CF 1302

Paperless

VITO

13. Application is made for a special license for overtime services of Customs officers and employees for:

Entrance, Clearance

Unlading, lading, etc.

Other:

Per supplemental

(Date)

(Time)

oral request

14. Bond No.

15. Application is made for a Term Permit and Special License

30-Sep-14

9910V2860

01-Oct-13

From:

To:

16. Principal on Bond

17. Surety Company Code

18. Amount of Bond

19. Date of Bond

Moran-Gulf Shipping Agencies, Inc.

$100,000.00

06-May-10

20. Importer Number

21. Address of Agent

595 Orleans Beaumont, Tx 77701

(Party to be billed: show hyphens)

22. Signature

23. Date

74-1826401

Vick Butler

13-Aug-14

This PERMIT is not valid until properly lodged with a Customs officer at the point of discharge and all operations indicated therein are performed under

Customs supervision.

*use back for additional space; (Instructions and Paperwork Reduction Act Notice on reverse)

Customs Form 3171 (05/10)