Customs Declaration FORMAPPROVED Oil,lB （报关FORMAPPROVED石油、磅）.pdfVIP

CustomsDeclaration FORMAPPROVED 19CFR122.27,148.12, 148.13,148.110,148.111,14S8i31CFR5316 Oil,lBNO.1651-0009 Eacharriving traveler or responsiblefamily member must provide the following information (only ONE wriften declaration per family is required): 1. FamilyName Ftlr.;t(Giorn) Middle 2. Birdr date D^y Month Year 3. Number of Family members traveling with you 4. (a) U.S. StreetAddress (hotel name/destination) (b)City (c) State 5. Passport issued by (country) 6. Passport number 7. Country of Residence 8. Countries visited on this rip prior to U.S. arrival 9. Airline/Flight No. or Vessel Name 10.The primary purposeof this trip is business: Yes No I l. I am (We are)bringing (a)fruits, vegetables,plants,seeds,food, insects: Yes No (b) meats,animals,animaVwildlife products: Yes No (c) disease cell agents, cultures,snails: Yes No (d) soil or havebeenon a fann/rancVpasture: Yes No 12.I haveQVehave)been in closeproximity of (such astouching or handling) livestock: Yes No I 3. I am (We are) carrying currency or monetary instruments over $10,000U.S. or foreign equivalent Yes No (seedefinition of monetary instrurnentson reverse) 14.I have (We have)commercial merchandise: Yes No (articlesfor sale,samplesusedfor soliciting orders, or goodsthat are not consideredperconaleffects) l5.Residents - the total value of all goods, including commercial merchandise I/we have purchasedor acquired abroad, (inc