Fillable U.S. Customs and Border Protection APPLICATION FOR EXEMPTION (ILW.COM)

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U.S. Customs and Border Protection APPLICATION FOR EXEMPTION (ILW.COM)

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The U.S. Customs and Border Protection APPLICATION FOR EXEMPTION (ILW.COM) form is 2 pages long and contains:

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  • 8 check-boxes
  • 156 other fields

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DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
CBP Form 442 (09/02)
11. Foreign Airport(s) Departure Name10. Arrival Airport
Code
9. Arrival Airport(s) Name & City/State
INTENDED AIRPORT(S) OF USE - NAME & CODES (if additional space is needed, provide attachments)
8. Current CBP
Decal #
7. Color Scheme6. Make/Model/Series5. Serial Number4. Country of Registration
3. Tail Number
AIRCRAFT INFORMATION (if additional space is needed, provide attachments)
PHONE FAX
PHONE FAX
SURETY NO.IRS NO.IRS NO. SURETY NO.
2. NAME OF OPERATOR (IF LEASED OR DIFFERENT FROM #1)
(Use Full Legal Name)
1. APPLICANT OR COMPANY NAME AND ADDRESS
(Use Full Legal Name)
APPLICANT NAME AND ADDRESS
DATE
DENIED
APPROVED
CBP USE ONLY
Please Print or Type
OMB No. 1651-0087
Expires 08/31/2012
12. Foreign Airport(s)
Departure Code
DATE OF SINGLE (MM/DD/YYYY):
OVERFLIGHT:
CHECK ALL THAT APPLY:
TERM
SINGLE
AMENDMENT RENEWAL
NO CHANGE
DELETION
APPLICATION FOR
EXEMPTION FROM SPECIAL LANDING REQUIREMENTS (OVERFLIGHT)
20. Name & Address: (Use Full Legal Name)
21. DOB
(mm/dd/yyyy)
22. SEX
23. Citizenship
Place of Birth
24. Passport and
/or Doc #
25. Social Security #
(optional)
26. List Usual Cargo or Baggage
SIGNATURE AND STATEMENT OF OWNER/APPLICANT
27. Owner Signature/ApplicantSignature 28. Date 29. Notary or CBP Officer's Signature (OVERFLIGHT) 30. Date
Mail Application to:
This application must be renewed every two (2) years (bi-annual) for the ''Term" Overflight program.
CBP Form 442 (09/02)(Back)
YES, Attach Explanation NO
This aircraft used with this Overflight Exemption (if approved) will be equipped with a Class "C'' Transponder. The aircraft will be operated above 12,500 feet
during normal flight conditions unless ordered to fly at a lower attitude by FAA flight controllers and IFR flight rules will apply when arriving from foreign ports.
The U.S. Customs and Border Protection Port of first intended landing will be notified in advance (24 hours or other local arrangements). The aircraft must be
available for inspection by CBP anytime. If the applicant has entered into a time-share or lease agreement with a particular aircraft, by signing below the
applicant agrees to having full operational control of the aircraft and all passengers, cargo, and crew that are being transported.
To the best of your knowledge has anyone on this application ever been convicted of any Federal, State, Military or Foreign Crime or Offense other than
Traffic Violations in this country or elsewhere? (Violations that occurred prior to a person's 16th birthday may be excluded).
I hereby certify that all the information given on this application is true and complete, and I authorize U.S Customs and Border Protection to perform whatever
checks are necessary to verify my eligibility for, and compliance with 19 CFR 122. I acknowledge that I have read the rules of this program and agree to abide
by them. I understand that significant penalties may be incurred by my business and/or me personally for non-compliance.
U.S. Customs and Border Protection
Attn: Overflight Desk
69 Terminal B
Newark IAP
Newark, NJ 07114
USUAL OR ANTICIPATED PASSENGERS (if additional space is needed, provide attachments)
USUAL OR ANTICIPATED CARGO (if additional space is needed, provide attachments)
19. Pilot
License #
18. Social Security #
(optional)
17. Passport
and /or Doc #
16. Citizenship
Place of Birth
15. SEX14. DOB
(mm/dd/yyyy)
13. Pilot/Crew Name & Address:
(Use Full Legal Name)
PILOT/CREW INFORMATION (if additional space is needed, provide attachments)
We are required by the Privacy Act to provide you with the following information: The authority for requesting the information is 5 USC
301 Treasury Department Order #165 revised as amended. Providing the information is mandatory for Private Aircraft Operators/
Passengers to participate in the CBP Overflight Program. The information or data may be given to federal, state or local law
enforcement agency when CBP becomes aware of violations or possible violations of civil or criminal law; to a federal agency when
conducting an investigation for security reasons, or to a court. If data or information is not provided, applicant(s) will not be approved to
participate in the program.
PRIVACY ACT NOTICE
PAPERWORK REDUCTION ACT NOTICE: Paperwork Reduction Act says the information collected on this application is needed to
carry out the Customs and Immigration laws of the United States. We need the information to insure that applicants meet the criteria
established to participate in the U.S Customs and Border Protection Overflight Exemption as per 19 CFR 122.25. The information
collected will be stored in a computer database for tracking purposes. Your response is required to obtain the benefits of
participation in the program. Statement required by 5 CFR 1320.21: The estimated average burden associated with collection of
information is 20 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 and Border Protection, Office of
Regulations and Rulings, 799, 9th Street, NW, Washington 20229.
CBP Form 442 (09/02)
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U.S. Customs and Border Protection APPLICATION FOR EXEMPTION (ILW.COM)

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Completed 9 January 2021

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