OMB No. 1140-0005 (11/30/2011)
U.S. Department of Justice
Application and Permit for Importation of
Bureau of Alcohol, Tobacco, Firearms and Explosives
Firearms Ammunition and Implements of War
Not for use by Members of the United States Armed Forces.
For ATF Use Only
For Applicant's Optional Use
Permit No. (Valid for 12 months from the date appearing in Item 18 below.) Internal Control #
Optional #
Section I - Application (Submit in triplicate) - For Applicant Use
1. Federal Firearms License (If Any)
2. Telephone No.
3. Country of Exportation
License No.
Expiration Date
4. Name and Address of Customs Broker (Including Zip Code)
5. Applicant's Name and Address (Including Zip Code)
Check here if permit is to be returned to Customs Broker.
Check here if permit is to be returned to applicant.
6. Name and Address of Foreign Seller, if any
7. Name and Address of Foreign Shipper
8. Description of Firearms and Ammunition (For firearms, enter (SG)-Shotgun; (RI)-Rifle; (PI)-Pistol; (RE)-Revolver; (DD)-Destructive Device; (MG)-Machinegun)
Type
Munitions
(SG, RI,
Caliber
Quantity
List
Model
Overall
New (N)
Name and Address
PI, RE,
Guage
(Each
Unit
Category
(Mfrs)
Length of
Length
Serial
or
of Manufacturer
DD, MG)
or Size
type)
Cost
Design
Barrel
(inches)
No.
Used (U)
a
b
c
d
e
f
g
h
i
j
k
Description
9. Certification of Origin. The items sought for importation
in block 8:
a. Do not contain parts or components produced by or
for the U.S. military and do not contain parts or com-
ponents manufactured with U.S. military technical
data or assistance.
(Ball
b. Contain parts or components produced by or for the
Wad-
U.S. military or parts or components manufactured
cutter,
with U.S. military technical data or assistance.
c. Contain parts or components produced by or for the
Shot,
U.S. military or components manufactured with U.S.
etc.)
technical data or assistance that were sold abroad
pursuant to a Direct Commercial Sale licensed by the
Department of State.
10. Specific Purpose of Importation, Including Final Recepient, If Known (Use additional sheets, if necessary)
11. Are You Registered as an Importer Pursuant to The Arms
12. If "Yes," Give Importer's Registration No. and Expiration Date
Export Control Act of 1976
Yes
No
Under the penalties provided by law, I declare that I have examined this application, including the documents submitted in support of it, and, to the best of
my knowledge and belief, it is true, correct, and complete.
13. Signature of Applicant
14. Title
15. Date
Section II - For ATF Use Only (please make no entries in this section)
16. The Application Has been Examined and the Importation of the Firearms, Ammunition, and Implements of War Described Herein is:
Dissaproved for the Reason Indicated Here
Returned Without Action for Additional
Approved
or on Attached Letter
Information
Partially Approved for the Reason
Withdrawn By Applicant Without Action
Indicated Here or on Attached Letter
17. Signature of the Director, Bureau of Alcohol, Tobacco, Firearms and Explosives
18. Date
ATF E-Form 6-Part I (5330.3A)
Revised October 2006