Fill - Free fillable CUSTOMS POWER OF ATTORNEY/ (Old Dominion Freight Line) PDF form

I.R.S. # 1.)

D-023 REV. 2/08

Individual

Partnership

Corporation

Sole Proprietorship

Limited Liability Company

2).

 appropriate box:

IN WITNESS WHEREOF, the said 7.)

caused these presents to be sealed and signed: (Signature) 8.)

(Capacity) 9.) Date: 10.)

Witness: (if required) 11.)

If you are the importer of record, payment to the broker will not relieve you of liability for U.S. Customs charges (duties, taxes or other

debts owed Customs) in the event the charges are not paid by the broker. Therefore, if you pay by check, Customs charges may be

paid with a separate check payable to the "U.S. Customs Service" which shall be delivered to Customs by the broker. Importers who

wish to utilize this procedure must contact our office in advance to arrange timely receipt of duty checks.

Make, endorse, sign, declare, or swear to any customs entry, withdrawal, declaration, certificate, bill of lading, carnet or any other

documents required by law or regulation in connection with the importation, exportation, transportation, of any merchandise in or

through the customs territory, shipped or consigned by or to said grantor;

Perform any act or condition which may be required by law or regulation in connection with such merchandise deliverable to said

grantor; to receive any merchandise;

Make endorsements on bills of lading conferring authority to transfer title; make entry or collect drawback; and to make, sign, declare,

or swear to any statement or certificate required by law or regulation for drawback purposes, regardless of whether such document is

intended for filing with Customs;

Sign, seal, and deliver for and as the act of said grantor any bond required by law or regulation in connection with the entry or

withdrawal of imported merchandise or merchandise exported with or without benefit of drawback, or in connection with the entry,

clearance, lading, unlading or navigation of any vessel or other means of conveyance owned or operated by said grantor, and any and

all bonds which may be voluntarily given and accepted under applicable laws and regulations, consignee's and owner's declarations

provided for in section 485, Tariff Act of 1930, as amended, or affidavits or statements in connection with the entry of merchandise;

Sign and swear to any document and to perform any act that may be necessary or required by law or regulation in connection with the

entering, clearing, lading, unlading, or operation of any vessel or other means of conveyance owned or operated by said grantor;

Authorize other Customs Brokers duly licensed within the territory to act as grantor's agent; to receive, endorse and collect checks

issued for Customs duty refunds in grantor's name drawn on the Treasurer of the United States; if the grantor is a nonresident of the

United States, to accept service of process on behalf of the grantor;

And generally to transact Custom business, including filing of claims or protests under section 514 of the Tariff Act of 1930, or

pursuant to other laws of the territories, in which said grantor is or may be concerned or interested and which may properly be

transacted or performed by an agent and attorney;

Giving to said agent and attorney full power and authority to do anything whatever requisite and necessary to be done in the premises

as fully as said grantor could do if present and acting, hereby ratifying and confirming all that the said agent and attorney shall lawfully

do by virtue of these presents;

This power of attorney to remain full force and effect until revocation in writing is duly given to and received by grantee (if the donor of

this power of attorney is a partnership, the said power shall in no case have any force or effect in the United States after the expiration

2 years from the dates of its execution);

Appointment as Forwarding Agent: Grantor authorizes the above Grantee to act within the territory as lawful agent and sign, endorse,

and/or file export documents (i.e., commercial invoices, bill of lading, shipper's export declaration, insurance certificates, drafts and

any other document) and submit export data electronically through the Automated Export System as necessary for the completion of

an export on grantor's behalf as may be required under law and regulation in the territory and to appoint forwarding agents on

grantor's behalf;

Grantor acknowledges receipt of A.N. Deringer Terms and Conditions of Services governing all transactions between the Parties.

If the Grantor is a Limited Liability Company, the signatory certifies that he/she has full authority to execute this power on behalf of the

Grantor.

KNOW ALL MEN BY THESE PRESENTS: That, 3.) doing

business as a 4)

under the laws of the State of 5.) ,

residing or having a principal place of business at 6.)

hereby constitutes and appoints A.N. Deringer, Inc., and its Officers and duly authorized Employees

, and/or specifically

authorized agents, to act for and on its behalf as a true and lawful agent and attorney of the grantor for and in the name, place and

stead of said grantor, from this date, in the United States (the "territory") either in writing, electronically, or by other authorized means,

to:

(Individual, partnership, corporation, sole proprietorship, or limited liability company)(insert one)

(Full name of individual, partnership, corporation, sole proprietorship, or limited liability company)(identify)

CUSTOMS POWER OF ATTORNEY/

DESIGNATION AS EXPORT FORWARDING AGENT

and Acknowledgment of Terms

and Conditions of Service

Reset Form

CITY 12.)

COUNTY 13.)

STATE 14.)

On this 15.) day of , 20 , personally appeared before me 16.)

residing at 17.) ,

personally known or sufficiently identified to me, who certifies that 18.)

(is) (are) the individual(s) who executed the foregoing instrument and acknowledge it to be 19.)

free act and deed.

20.)

ss:

CORPORATE CERTIFICATION

(To be made by an officer of other than the one who executes the power of attorney)

I, 21.) , certify that I am the 22.)

of 23.) , organized under the laws of the State of 24.)

that 25.) , who signed this power of attorney on behalf of the donor, is the

26.)

of said corporation; and that said power of attorney was duly signed, sealed,

and attested for and in behalf of said corporation by authority of its governing body as the same appears in a resolution of the Board

of Directors passed at a regular meeting held on the 27.)

day of , 20 now in my possession or custody.

I further certify that the resolution is in accordance with the articles of incorporation and bylaws of said corporation, and was executed

in accordance with the laws of the State or Country of Incorporation.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said corporation, at the City of 28.)

this 29.) day of , 20 .

30.)

31).

INDIVIDUAL OR PARTNERSHIP CERTIFICATION

(Notary Public)

(Signature) (Date)

D-023 REV. 2/08

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D-023 REV. 2/08

1.) Please indicate your corporate I.R.S. #/Social Security # (Whichever is applicable) - for U.S. Companies only.

2.) Check appropriate box to indicate company status.

3.) Individual — State persons name.

Partnership — Indicate full name of each partner and partnership name.

Sole Proprietorship — Indicate full name of individual and company.

Corporation — Indicate full legal company name.

4.) Company name if other than as stated in #3.

5.) Corporations only — Indicate the state, province or country under whose laws you operate.

6.) Official physical address of the companies' home office, or individual home address.

7.) Typed/printed name of individual signing power of attorney. If a corporation, the individual must be a corporate

officer. (i.e. – President, Vice-President, Secretary or Treasurer)

8.) Signature of individual indicated in #7.

9.) Title of individual indicated in #8.

10.) Date power of attorney is being granted.

11.) Name and signature of witness. (Not required unless specifically required by your

State/Provincial/Federal government)

Note: Only non-resident corporations must complete the corporate certification section.

12.) -20.) No longer required unless specifically required by your State/Provincial/Federal government.

21.) Name of individual officer executing the corporate certification.

22.) Title of individual indicated in #21.

23.) Name of corporation.

24.) Indicate the state, province or country under whose laws your company operates.

25.) Name of person signing front of power of attorney. (Same as #8)

26.) Title of person signing front of power of attorney. (Same as #9)

27.) Date the corporation recognized granting power of attorney to A.N. Deringer, Inc.

28.) -29.) Not necessary unless specifically required by your State/Provincial/Federal government.

30.) Signature of officer executing the corporate certification.

31.) Date

* ALL SPACES MUST BE FILLED IN UNLESS OTHERWISE INDICATED.

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Terms & Conditions of Service

These terms and conditions of service constitute a legally binding contract between the "Company" and the

"Customer". In the event the Company renders services and issues a document containing Terms and Conditions

governing such services, the Terms and Conditions set forth in such other document(s) shall govern those services.

1.Definitions.

(a) "Company" shall mean A. N. Deringer, Inc., its subsidiaries, related companies, agents and/or

representatives;

(b) "Customer" shall mean the person for which the Company is rendering service, as well as its agents

and/or representatives, including, but not limited to, shippers, importers,

exporters, carriers, secured parties, warehousemen, buyers and/or sellers, shipper's agents, insurers and

underwriters, break-bulk agents, consignees, etc. It is the responsibility of the Customer to provide notice and

copy(s)of these terms and conditions of service to all such agents or representatives;

paper or electronic form;

(d)"Ocean Transportation Intermediaries" ("OTI") shall include an "ocean freight forwarder" and a "non-

vessel operating carrier";

(e) "Third parties" shall include, but not be limited to, the following: "carriers, truckmen, cartmen,

lightermen, forwarders, OTIs, customs brokers, agents, warehousemen and others to which the goods are entrusted

for transportation, cartage, handling and/or delivery and/or storage or otherwise".

2. Company as agent. The Company acts as the "agent" of the Customer for the purpose of performing duties in

connection with the entry and release of goods, post entry services, the securing of export licenses, the filing of

export and security documentation on behalf of the Customer and other dealings with Government Agencies: as to

all other services, Company acts as an independent contractor.

3. Limitation of Actions.

(a) Unless subject to a specific statute or international convention, all claims against the Company for a

potential or actual loss, must be made in writing and received by the Company, within ninety (90) days of the

event giving rise to claim; the failure to give the Company timely notice shall be a complete defense to any suit or

action commenced by Customer.

(b) All suits against Company must be filed and properly served on Company as follows:

(i) For claims arising out of ocean transportation, within one (1) year from the date of the loss;

(ii) For claims arising out of air transportation, within two (2) years from the date of the loss;

(iii) For claims arising out of the preparation and/or submission of an import entry(s), within

seventy-five (75) days from the date of liquidation of the entry(s);

(iv) For any and all other claims of any other type, within two (2) years from the date of the loss or

damage.

4. No Liability For The Selection or Services of Third Parties and/or Routes. Unless services are performed by

persons or firms engaged pursuant to express written instructions from the Customer, Company shall use

reasonable care in its selection of third parties, or in selecting the means, route and procedure to be followed in the

handling, transportation, clearance and delivery of the shipment; advice by the Company that a particular person or

firm has been selected to render services with respect to the goods, shall not be construed to mean that the

Company warrants or represents that such person or firm will render such services nor does Company assume

responsibility or liability for any actions(s)and/or inaction(s) of such third parties and/or its agents, and shall not be

liable for any delay or loss of any kind, which occurs while a shipment is in the custody or control of a third party

or the agent of a third party; all claims in connection with the Act of a third party shall be brought solely against

such party and/or its agents; in connection with any such claim, the Company shall reasonably cooperate with the

Customer, which shall be liable for any charges or costs incurred by the Company.

5. Quotations Not Binding. Quotations as to fees, rates of duty, freight charges, insurance premiums or other

charges given by the Company to the Customer are for informational purposes only and are subject to change

without notice; no quotation shall be binding upon the Company unless the Company in writing agrees to

undertake the handling or transportation of the shipment at a specific rate or amount set forth in the quotation and

payment arrangements are agreed to between the Company and the Customer.

6. Reliance On Information Furnished.

(a) Customer acknowledges that it is required to review all documents and declarations prepared and/or

filed with U.S. Customs & Border Protection, other Government Agency and/or third parties, and will immediately

advise the Company of any errors, discrepancies, incorrect statements, or omissions on any declaration or other

submission filed on Customers behalf;

(b) In preparing and submitting customs entries, export declarations, applications, security filings,

documentation and/or other required data, the Company relies on the correctness of all documentation, whether in

written or electronic format, and all information furnished by Customer; Customer shall use reasonable care to

ensure the correctness of all such information and shall indemnify and hold the Company harmless from any and

all claims asserted and/or liability or losses suffered by reason of the Customer's failure to disclose information or

any incorrect, incomplete or false statement by the Customer or its agent, representative or contractor upon which

the Company reasonably relied. The Customer agrees that the Customer has an affirmative non-delegable duty to

disclose any and all information required to import, export or enter the goods.

7. Declaring Higher Value To Third Parties. Third parties to whom the goods are entrusted may limit liability

for loss or damage; the Company will request excess valuation coverage only upon specific written instructions

from the Customer, which must agree to pay any charges therefore; in the absence of written instructions or the

refusal of the third party to agree to a higher declared value, at Company's discretion, the goods may be tendered to

the third party, subject to the terms of the third party's limitations of liability and/or terms and conditions of

service.

8. Insurance. Unless requested to do so in writing and confirmed to Customer in writing, Company is under no

obligation to procure insurance on Customer's behalf; in all cases, Customer shall pay all premiums and costs in

connection with procuring requested insurance.

9. Disclaimers; Limitation of Liability.

(a)Except as specifically set forth herein, Company makes no express or implied warranties in connection with its

services;

(b) In connection with all services performed by the Company, Customer may obtain additional liability

coverage, up to the actual or declared value of the shipment or transaction, by requesting such coverage and

agreeing to make payment therefor, which request must be confirmed in writing by the Company prior to rendering

services for the covered transaction(s).

following:

(i) where the claim arises from activities other than those relating to customs business, $ 50.00 per

shipment or transaction, or

(ii) where the claim arises from activities relating to "Customs business," $ 50.00 per entry or the

amount of brokerage fees paid to Company for the entry, whichever is less;

(d) In no event shall Company be liable or responsible for consequential, indirect, incidental, statutory or

punitive damages, even if it has been put on notice of the possibility of such damages, or for the acts of third

parties.

10. Advancing Money. All charges must be paid by Customer in advance unless the Company agrees in writing to

extend credit to customer; the granting of credit to a Customer in connection with a particular transaction shall not

be considered a waiver of this provision by the Company.

11. Indemnification/Hold Harmless. The Customer agrees to indemnify, defend, and hold the Company harmless

from any claims and/or liability, fines, penalties and/or attorneys' fees arising from the importation or exportation

of customers merchandise and/or any conduct of the Customer, including but not limited to the inaccuracy of entry,

export or security data supplied by Customer or its agent or representative, which violates any Federal, State and/or

other laws, and further agrees to indemnify and hold the Company harmless against any and all liability, loss,

damages, costs, claims, penalties, fines and/or expenses, including but not limited to reasonable attorney's fees,

which the Company may hereafter incur, suffer or be required to pay by reason of such claims; in the event that

any claim, suit or proceeding is brought against the Company, it shall give notice in writing to the Customer by

mail at its address on file with the Company.

12. C.O.D. or Cash Collect Shipments. Company shall use reasonable care regarding written instructions relating

to "Cash/Collect on Deliver (C.O.D.)" shipments, bank drafts, cashier's and/or certified checks, letter(s)of credit

and other similar payment documents and/or instructions regarding collection of monies but shall not have liability

if the bank or consignee refuses to pay for the shipment.

13. Costs of Collection. In any dispute involving monies owed to Company, the Company shall be entitled to all

costs of collection, including reasonable attorney's fees and interest at 15% per annum or the highest rate allowed

by law, whichever is less unless a lower amount is agreed to by Company.

14. General Lien and Right To Sell Customer's Property.

(a) Company shall have a general and continuing lien on any and all property of Customer coming into

Company's actual or constructive possession or control for monies owed to Company with regard to the shipment

on which the lien is claimed, a prior shipment(s)and/or both;

(b) Company shall provide written notice to Customer of its intent to exercise such lien, the exact amount

of monies due and owing, as well as any on-going storage or other charges; Customer shall notify all parties

having an interest in its shipment(s)of Company's rights and/or the exercise of such lien.

if the amount due is in dispute, an acceptable bond equal to 110%of the value of the total amount due, in favor of

Company, guaranteeing payment of the monies owed, plus all storage charges accrued or to be accrued, Company

shall have the right to sell such shipment(s)at public or private sale or auction and any net proceeds remaining

thereafter shall be refunded to Customer.

15. No Duty To Maintain Records For Customer. Customer acknowledges that pursuant to Sections 508 and

509 of the Tariff Act, as amended, (19 USC §I508 and 1509) it has the duty and is solely liable for maintaining all

records required under the Customs and/or other Laws and Regulations of the United States; unless otherwise

agreed to in writing, the Company shall only keep such records that it is required to maintain by Statute(s) and/or

Regulation(s),but not act as a "recordkeeper" or "recordkeeping agent" for Customer.

16. Obtaining Binding Rulings, Filing Protests, etc. Unless requested by Customer in writing and agreed to by

Company in writing, Company shall be under no obligation to undertake any pre-or post Customs release action,

including, but not limited to, obtaining binding rulings, advising of liquidations, filing of petition(s) and/or

protests, etc.

17. Preparation and Issuance of Bills of Lading. Where Company prepares and/or issues a bill of lading,

Company shall be under no obligation to specify thereon the number of pieces, packages and/or cartons, etc.;

unless specifically requested to do so in writing by Customer or its agent and Customer agrees to pay for same,

Company shall rely upon and use the cargo weight supplied by Customer.

18. No Modification or Amendment Unless Written. These terms and conditions of service may only be

modified, altered or amended in writing signed by both Customer and Company; any attempt to unilaterally

modify, alter or amend same shall be null and void.

19. Compensation of Company. The compensation of the Company for its services shall be included with and is

in addition to the rates and charges of all carriers and other agencies selected by the Company to transport and deal

with the goods and such compensation shall be exclusive of any brokerage, commissions, dividends, or other

revenue received by the Company from carriers, insurers and others in connection with the shipment. On ocean

exports, upon request, the Company shall provide a detailed breakout of the components of all charges assessed

and a true copy of each pertinent document relating to these charges. In any referral for collection or action against

the Customer for monies due the Company, upon recovery by the Company, the Customer shall pay the expenses

of collection and/or litigation, including a reasonable attorney fee.

20. Severability. In the event any Paragraph(s) and/or portion(s) hereof is found to be invalid and/or

unenforceable, then in such event the remainder hereof shall remain in full force and effect. Company's decision to

waive any provision herein, either by conduct or otherwise, shall not be deemed to be a further or continuing

waiver of such provision or to otherwise waive or invalidate any other provision herein.

21. Governing Law; Consent to Jurisdiction and Venue. These terms and conditions of service and the

relationship of the parties shall be construed according to the laws of the State of Vermont without giving

consideration to principals of conflict of law.

Customer and Company

(a) irrevocably consent to the jurisdiction of the United States District Court and the State courts of

Vermont;

(b) agree that any action relating to the services performed by Company, shall only be brought in said

courts;

(d) further agree that any action to enforce a judgment may be instituted in any jurisdiction.

Terms and conditions

Initials

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<Date>

Bond Department

A N Deringer, Incorporated

64 N Main Street

Saint Albans, VT 05478

Dear Sir or Madam:

Grantor waives the confidentiality requirements of Sections 111.24 of the

Customs Regulations and the requirement in Section 111.36 of the Customs

Regulations that the Customs Broker transmit a copy of its bill for service directly

to the importer, and authorizes the Customs Broker to transmit its bill for services

and copies of the Customs entry documents and related documents (CBP-7501

or other documents used to make entry, commercial invoices, etc.)

through Grantor's forwarder Mantoria Inc., 4492 Sainte Catherine St. W.,

Westmount, QC, H3Z 1R7. No part of this agreement or any other agreement

forbids or prevents direct communication between the importer or other party in

interest and the Customs Broker.

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CUSTOMS POWER OF ATTORNEY (Old Dominion Freight Line)

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