Form Op-1(Nna) - Application For U.s. Department Of Transportation (Usdot) Registration By Non-North America-Domiciled Motor Carriers Page 17

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OMB No.: 2126-0016 Expiration: 01/31/2020
FORM OP-1(NNA) Revised 01/10/2017
Section
HOUSEHOLD GOODS
6
REQUIREMENTS
HOUSEHOLD GOODS MOTOR CARRIER APPLICANTS MUST :
1. Provide evidence of participation in an arbitration program and a copy of the notice they provide to shippers of the availability of
binding arbitration.
2. Identify their tariff and provide a copy of the notice to shippers of the availability of that tariff for inspection, indicating how that
notice is provided.
3. Disclose all relationships involving common stock, common ownership, common management, or common familial relationships
between the applicant and any other motor carrier, freight forwarder, or broker of household goods within 3 years of the date of
the filing of this application.
Applicant certifies that it has access to, has read, is familiar with, and will observe all applicable Federal laws relating to consumer
protection, estimating, consumers’ rights and responsibilities, and options for limitations of liability for loss and damage.
APPLICANT SIGNATURE
Common
Common
Common
Family
Name of affiliated company
Stock
Ownership
Management
Relation
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
ATTACH
FILE
Section
SCOPE OF REGISTRATION
7
SOUGHT
1. Applicant seeks to provide the following transportation service in foreign/international commerce (check all that apply):
For a non-North American carrier to transport property between points outside of United States and all points in the United States.
For non-North American passenger carriers, charter and tour bus operations between points outside of United States and points
in the United States.
For a non-North American passenger carrier to provide transportation services as a private motor carrier of passengers.
2. Indicate the principal border crossing points which applicant intends to utilize:
ATTACH
FILE
FORM OP-1(NNA) Instructions • Page 13 of 16

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