Customs Form 3495 - Application For Exportation Of Articles Under Special Bond

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DEPARTMENT OF THE TREASURY
Form Approved
O.M.B. No. 1515-0009
UNITED STATES CUSTOMS SERVICE
APPLICATION FOR EXPORTATION OF ARTICLES UNDER SPECIAL BOND
19 CFR 10.38
TO CUSTOMS PORT DIRECTOR
1. TO: Customs Port Director(Address)
2. FROM: (Name and Address of Importer or Agent)
ATTACH COPY OF EXPORT INVOICE DESCRIBING ARTICLES TO BE EXPORTED
3. Name of Exporting Carrier
4. Date of Departure
5. Country of Origin
6. No. of Export Packages
7. Port of Entry
8. Entry Number and Date
9. Date Bonded Period Expires
10. Date Articles Available for Customs Examination
11. Signature of Importer or Agent
12. Date
(FOR CUSTOMS USE ONLY)
NOTICE TO IMPORTER TO DELIVER ARTICLES TO BE EXAMINED AND IDENTIFIED FOR EXPORTATION
13. Place and Date of Customs Examination
14. DATE
15. CUSTOMS PORT DIRECTOR
BY:
REPORT OF EXAMINATION
16. The articles covered by this application have been examined and agree with the invoice in content and No. of export pkgs. and are approved for export.
17. No. of Export Packages
18. Date of Delivery for Exportation
19. Marks and Numbers on Export Packages
20. The articles covered by this application do not agree with the invoice in content or in number of packages as follows
21. SIGNATURE OF EXAMINING CUSTOMS OFFICER
22. DATE
REPORT OF EXPORTATION
23. Home of Exporting Conveyance (Vessel, Railroad, Airline and Flight Number)
24. Date of Departure
25. Manifest No.
Paperwork Reduction Act Notice: The Paperwork Reduction Act of 1980 says we must tell you why we are
collecting this information, and whether you have to give it to us. We need this information to ensure that
importers and ex porters are complying with the customs laws of the United States and allow us to figure and
collect the right amount of revenue. Your response is mandatory.
Statement Required by 5 CFR 1320.21: The estimated av erage burden associated with this collection of
26. SIGNATURE OF CUSTOMS OFFICER
information is 8 minutes per respondent or recordkeeper depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed
to U.S. Customs Service, Paperwork Management Branch, Washington DC 20229.
DO NOT send
completed form(s) to this office.
(EDITIONS PRIOR TO 11/67 ARE OBSOLETE)
(Customs officer must return one copy of this
Customs Form 3495 (080195)
form to port of origin upon exportation.)

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