Fillable Form 654321: U.S. Customs and Border Protection VESSEL (ILW.COM)

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Form 654321: U.S. Customs and Border Protection VESSEL (ILW.COM)

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The Form 654321: U.S. Customs and Border Protection VESSEL (ILW.COM) form is 2 pages long and contains:

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  • 23 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

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654321
Tonnage Tax Paid Up *APHIS User Fee Paid Up*CBP User Fee Paid Up*
Not SubmergedSubmergedNone
Check if Complete Manifest filed for Export
Check if Licensed Cargo Loaded
Check if Incomplete Manifest for Export
CLEARANCEENTRANCE
20. List All Carriers on
board by SCAC Code
15. Particulars of Voyage (Previous and subsequent Ports of Call, include dates; underline where remaining cargo will be discharged)
(Con't on back)
FOR CBP USE ONLY
VESSEL ENTRANCE OR CLEARANCE STATEMENT
Approved OMB. No. 1651-0019
Exp. 12-31-2011
TRADE CODES
(see back)
1. Manifest No. 2. Port Arrival/Departure 3. Date & Time of Arrival/Departure 4. Vessel Operating Draft (in feet and inches)
Check One:
5. Nationality, Name and Type of Vessel 6. Vessel Built at/Year 7. Name, Address & Phone No. of
Ship's Agent
8. Name & Country of Owner 9. Name & Country of Operator
10. Gross Tonnage 13. IMO # Official # Call Sign
14. List All Dock Locations (continue on back if necessary)
16. Brief Description of Cargo
17.
18. No. of Crew
21. Tonnage Mark 22. Bunkers: Type,
Barrels, Value
23. Load Line Expires 24. Solas Certificate Expires 25. Passengers Allowed Per
Coast Guard Certificate
26. No. of Passengers
Embarking/Disembarking
27. Cert. Of Fin. Resp. No. (Water Pollution)
and Exp. Date
28. Cert. Of Fin. Resp. (Passenger Death/
Injury)
29. Cert. Of Fin. Resp. (Passenger
Transportation Indemnification)
30. PURPOSE OF ENTRANCE OR CLEARANCE
31. Print and Sign Name of Master, Authorized Agent or Officer, Date
32. 33. 34.
35. Cash Receipt, CBP 368 or Transaction No. 36. Total Fees Collected 37. Port Entered/Cleared, Time and Date
38. CBP Officer Remarks
39. Signature and Title of Officer Receiving Entry/Granting Clearance
*Check boxes only if fees not collected
CBP Form 1300 (06/09)
19 CFR Part 4
ft. in.
F (FROB - Foreign Cargo to Remain on Board)
D (Discharge Foreign Cargo) X (Export Cargo Aboard on Arrival)
N (No Cargo transactions)
L (Lade Cargo for Export)
Y (Military Cargo for Discharge/to be Laden)
See back for Instructions
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
12. Port Arrived From/Departed For11. Net Tonnage
19. No. of Passengers
Foreign General Cargo
INSTRUCTIONS
Trade Codes: Please enter the code that best describes the arriving or departing vessel
(6)
(5)
(4)
(3)
(2)
Domestic or Coastwise General Cargo
Foreign Bulk
Foreign in Ballast
Deepest draft of the vessel on entrance (in feet and inches)
Block 4 - Vessel Operating Draft: (not the design draft)
Block 5 - Vessel Types: List one of the codes and descriptions from below:
341
340
333
330
325
310
229
210
150
140
112
111
Dry Cargo Barge
Deck Barge
RO-RO Cargo
General Cargo
Vehicle Carrier
Container
Bulk Carrier
Bulk/Oil Carrier
Other Tanker
Tank Barge
Crude/Products Tanker
Crude Oil Tanker
600
499
494
493
492
432
431
422
421
410
350
Block 14 - Additional Information
Block 9 - Operator as listed on the Certificate of Financial Responsibility (Water Pollution): unless other verifiable charter or lease
arrangement indicates otherwise.
CBP Form 1300 (06/09)(Back)
Domestic or Coastwise Ballast
Passenger
Fish Processing & Catching
Drilling Ship
Tug/Supply Offshore Support
Tug/Tow Boat
Pushboat
Research/Survey
Dredger
Yacht
Other NEI
Lakers Vessels
Block 15 - Additional Information
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to
respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this
collection is 1651-0019. The estimated average time to complete this application is 30 minutes. If you have any comments regarding
the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW.,
Washington DC 20229.
Deepest draft of the vessel on clearance (in feet and inches)
(1)
Domestic or Coastwise Bulk
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Form 654321: U.S. Customs and Border Protection VESSEL (ILW.COM)

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Completed 9 January 2021

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