Fillable 19 CFR 10.1(a)(1) Foreign Shipper Declaration

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19 CFR 10.1(a)(1) Foreign Shipper Declaration

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19 CFR 10.1(a)(1) Foreign Shipper Declaration
Client Reference Number:
Serial Number/Identifying Marks:
Entry Number:
I, _______________, declare that to the best of my knowledge and belief the
articles were exported from the United States, from the port of
______________ on or about _________________, 20__, and they are
returned without having been advanced in value or improved in condition by
any process of manufacture or other means.
Marks
Number Quantity Description
Value, in US
Coin
(
Date
)
(
Signature
)
(
Address
)
(
Capacity
)
Title 19 CFR 10.1(a)(1) requires a declaration by foreign shipper in substantially the above format
to be filed in connection with the entry of articles in a shipment valued over $2,000 and claimed to
be free of duty under subheading 9801.00.10 or 9802.00.20, Harmonized Tariff Schedule of the
United States (HTSUS). For additional CBP requirements/information regarding US Goods
Returned shipments, please refer to the CBP regulations (
http://ecfr.gpoaccess.gov/cgi/t/text/text-
idx?c=ecfr&sid=27c5fbacbebf8e20ad31c2f7e546137d&rgn=div8&view=text&node=19:1.0.1.1.5.1.
92.1&idno=19).
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19 CFR 10.1(a)(1) Foreign Shipper Declaration

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Completed 3 November 2021

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