19 CFR 10.1(a)(2) Declaration by Owner, Importer, or Consignee:
Client Reference Number:
Serial Number/Identifying Marks:
Entry Number:
I, _______________, declare that the (above/attached) declaration by the
foreign shipper is true to the best of my knowledge and belief, that the articles
were manufactured by _______________ (name of the manufacturer) located
in _______________ (city and state), that the articles were not manufactured
or produced in the United States under subheading 9813.00.05 HTSUS, and
that the articles were exported from the US without benefit of drawback.
(Date)
(Signature)
Title 19 CFR 10.1(a)(2) declaration by the owner, importer, consignee, or agent having knowledge of the facts regarding
the claim for duty free entry. If the owner or ultimate consignee is a corporation, such declaration may be signed by the
president, vice president, secretary, or treasurer of the corporation, or may be signed by any employee or agent of the
corporation who holds a power of attorney executed under the conditions outlined in subpart C, part 141 of this chapter
and a certification by the corporation that such employee or other agent has or will have knowledge of the pertinent facts
and in shall be in substantially the above form as per US customs 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).
