Tsca Import Certification Form printable pdf download

Tsca Import Certification Form

TSCA IMPORT CERTIFICATION FORM

Importer Instructions:

Complete this form if you intend to import a new chemical into the U.S. Importing includes:

Carrying the chemical on your person or carrying it in your baggage;

Shipping the chemical through the mail or express services (FedEx, UPS, etc.); or

Ordering the chemical directly through a foreign vendor.

NOTE: If you are importing the chemical through a supplier distributor such as VWR, Fisher Scientific, or

another domestic vendor, they will take responsibility for submitting the import certification.

Forward a completed copy of this form along with a Purchase Order to the foreign vendor/shipper for

inclusion with the shipment.

Retain a copy of this form and accompanying shipping papers for 3 years.

4) Check with JQ to determine if pre-manufacture notice requirements apply (if not for R&D).

5) Include this form with the shipment so that it will be available to U.S. Customs upon entering the country.

Name of Person Completing this form (please print):

Department:

Phone:

Lab Group/principal Investigator:

The chemicals listed on this form are imported into the US Customs territory via:

Personal conveyance, or

Mail or express service, or

Foreign Vendor / Customs Broker, and

Chemicals listed below will be used for research and development purposes only.

In accordance with the Toxic Substance Control Act (TSCA) Section 13, Import Certification, and 40 CFR 707, I

hearby certify that all chemical substances in this shipment comply with all applicable rules and orders

under TSCA and that I am not offering a chemical substance for entry in violation of TSCA or any

applicable rule or order thereunder.

SHIPMENT CONTENTS

Attach additional sheets that identify the chemicals to be shipped. Include the following information:

CAS

Structure

Formula

Lab Notebook Number

Name:

Company:

Address:

Phone:

Contact Name:

Phone:

Importer Signature:

Date:

Version 1

07 OCT 09

Tsca Import Certification Form