Form 7525-V - Shipper'S Export Declaration - U.s. Department Of Commerce

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U.S. DEPARTMENT OF COMMERCE —
U.S. CENSUS BUREAU – Economics and Statistics Administration — BUREAU OF EXPORT ADMINISTRATION
7525-V
SHIPPER’S EXPORT DECLARATION
OMB No. 0607-0152
FORM
(7-25-2000)
1a. U.S. PRINCIPAL PARTY IN INTEREST (USPPI)
(Complete name and address)
ZIP CODE
2. DATE OF EXPORTATION
3. TRANSPORTATION REFERENCE NO.
b. USPPI EIN (IRS) OR ID NO.
c. PARTIES TO TRANSACTION
Related
Non-related
4a. ULTIMATE CONSIGNEE
(Complete name and address)
b. INTERMEDIATE CONSIGNEE
(Complete name and address)
5. FORWARDING AGENT
(Complete name and address)
6. POINT (STATE) OF ORIGIN OR FTZ NO.
7. COUNTRY OF ULTIMATE DESTINATION
8. LOADING PIER (Vessel only)
9. METHOD OF TRANSPORTATION (Specify)
14. CARRIER IDENTIFICATION CODE
15. SHIPMENT REFERENCE NO.
16. ENTRY NUMBER
17. HAZARDOUS MATERIALS
10. EXPORTING CARRIER
11. PORT OF EXPORT
Yes
No
18. IN BOND CODE
19. ROUTED EXPORT TRANSACTION
12. PORT OF UNLOADING (Vessel and air only)
13. CONTAINERIZED (Vessel only)
Yes
No
Yes
No
20. SCHEDULE B DESCRIPTION OF COMMODITIES (Use columns 22–24)
VALUE (U.S. dollars,
VIN/PRODUCT NUMBER/
omit cents)
QUANTITY –
(Selling price or cost if not
VEHICLE TITLE NUMBER
SHIPPING WEIGHT
D/F
SCHEDULE B NUMBER
SCHEDULE B UNIT(S)
sold)
or M
(Kilograms)
(21)
(22)
(23)
(24)
(25)
(26)
27. LICENSE NO./LICENSE EXCEPTION SYMBOL/AUTHORIZATION
28. ECCN (When required)
The USPPI authorizes the forwarder named above
29. Duly authorized officer or employee
to act as forwarding agent for export control and
customs purposes.
Clear fields 1-19
30.
I certify that all statements made and all information contained herein are true and correct and that I have
read and understand the instructions for preparation of this document, set forth in the "Correct Way to
Fill Out the Shipper’s Export Declaration." I understand that civil and criminal penalties, including
forfeiture and sale, may be imposed for making false or fraudulent statements herein, failing to provide
the requested information or for violation of U.S. laws on exportation (13 U.S.C. Sec. 305; 22 U.S.C. Sec.
Clear fields 21-98
401; 18 U.S.C. Sec. 1001; 50 U.S.C. App. 2410).
Signature
Confidential – For use solely for official purposes authorized by the
Secretary of Commerce (13 U.S.C. 301 (g)).
Title
Export shipments are subject to inspection by U.S. Customs Service
Clear fields 99-102
and/or Office of Export Enforcement.
Date
31. AUTHENTICATION (When required)
Telephone No. (Include Area Code)
E-mail address
Clear all fields
This form may be printed by private parties provided it conforms to the official form. For sale by the Superintendent of Documents,
Government Printing Office, Washington, DC 20402, and local Customs District Directors. The "Correct Way to Fill Out the Shipper’s
Export Declaration" is available from the U.S. Census Bureau, Washington, DC 20233.

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