Power Of Attorney Form U.s. Principal Party In Interest / Authorized Agent
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1Power of Attorney
U.S. Principal Party in Interest / Authorized Agent
US CUSTOMS
Know all men by these presents, that____________________________________, the USPPI organized and doing
business under the laws of the State or Country of __________________________ and having an office and place of
business at _______________________________________ hereby authorizes_____________________________,
(Address of USPPI)
(Authorized Agent)
(Name of Authorized Agent) of______________________________________________________________________
(Address of Authorized Agent)
to act for and on its behalf as a true and lawful agent and attorney of the U.S. Principal Party in Interest (USPPI) for, and
in the name, place, and stead of the USPPI, from this date, in the United States either in writing, electronically, or by
other authorized means to: act as authorized agent for export control, U.S. Census Bureau (Census Bureau) reporting,
and U.S. Customs and Border Protection (CBP) purposes. Also, to prepare and transmit any Electronic Export
Information (EEI) or other documents or records required to be filed by the Census Bureau, CBP, the Bureau of Industry
and Security, or any other U.S. Government agency, and perform any other act that may be required by law or regulation
in connection with the exportation or transportation of any goods shipped or consigned by or to the USPPI, and to receive
or ship any goods on behalf of the USPPI.
The USPPI hereby certifies that all statements and information contained in the documentation provided to the authorized
agent and relating to exportation will be true and correct. Furthermore, the USPPI understands that civil and criminal
penalties may be imposed for making false or fraudulent statements or for the violation of any United States laws or
regulations on exportation.
This power of attorney is to remain in full force and effect until revocation in writing is duly given by the U.S. Principal
Party in Interest and received by the Authorized Agent.
IN WITNESS WHEREOF, ____________________________________ caused these presents to be sealed and signed:
Witness:
____________________________
Signature:
______________________________
Capacity:
___________________________
Date:
_____________
For US Branch contact information, please visit
November 2015
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