Cbp Form 3499 - Application And Approval To Manipulate, Examine, Sample Or Transfer Goods
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1
2DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
APPLICATION AND APPROVAL
TO MANIPULATE, EXAMINE, SAMPLE OR TRANSFER GOODS
Form Approved
OMB No. 1651-0006
19 CFR 19.8, 19.11, 158.43
Exp. 12-31-2016
1. GOODS CONSIGNED TO (Name)
2. GOODS EXPORTED FROM
3. PORT/PORT CODE AND DATE OF APPLICATION
4. LOCATION OF GOODS
5. CARRIER OR SHIP (Name)
6. BILL OF LADING OR CBP 7512 NO.
7. IS AREA BONDED?
8. ENTRY INFORMATION
Number:
YES
NO
Warehouse
Consumption
Date:
PERMISSION IS REQUESTED TO:
(Describe the complete operation to be performed under CBP supervision on the goods listed below):
FOR CBP USE ONLY
9. MARKS AND NUMBERS
11. MANIPULATED VALUE
10. DESCRIPTION
12. SIGNATURE OF APPLICANT
APPROVED
13. DATE
14. SIGNATURE AND TITLE OF APPROVING CBP OFFICER
See Page 2 of form for Paperwork Reduction Act Notice.
Customs and Border Protection Officers Report on Reverse
CBP Form 3499 (12/16)
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