Shipper's Export Declaration

U.S. DEPARTMENT OF COMMERCE – Economics and Statistics Administration – U.S. CENSUS BUREAU – BUREAU OF EXPORT ADMINISTRATION
FORM

7525-V(7-18-2003)

SHIPPER’S EXPORT DECLARATION

OMB No.0607-0152

1a. U.S. PRINCIPAL PARTY IN INTEREST (USPPI)(Complete name and address) 2. DATE OF EXPORTATION 3. TRANSPORTATION REFERENCE NO.

ZIP CODE

b. USPPI’S EIN (IRS) OR ID NO.

c. PARTIES TOTRANSACTION Related Non-related

4a. ULTIMATE CONSIGNEE (Complete name and address)

b. INTERMEDIATE CONSIGNEE (Complete name and address)

5a. FORWARDING AGENT (Complete name and address)

5b.FORWARDING AGENT’S EIN (IRS) NO. 8. LOADING PIER (Vessel only) 9. METHOD OF TRANSPORTATION (Specify)

6. POINT (STATE) OF ORIGIN OR FTZ NO.

7. COUNTRY OF ULTIMATE DESTINATION

14. CARRIERIDENTIFICATION CODE 16. ENTRY NUMBER

15. SHIPMENT REFERENCE NO. 17. HAZARDOUS MATERIALS Yes No

10. EXPORTING CARRIER

11. PORT OF EXPORT

12. PORT OF UNLOADING (Vessel and air only)

13.CONTAINERIZED (Vessel only) Yes No

18. IN BOND CODE

19. ROUTED EXPORT TRANSACTION Yes VIN/PRODUCT NUMBER/ VEHICLE TITLE NUMBER (25) No VALUE (U.S. dollars, omit cents) (Selling price or cost if notsold) (26)

20. SCHEDULE B DESCRIPTION OF COMMODITIES (Use columns 22–24) D/F or M (21) SCHEDULE B NUMBER (22) QUANTITY – SCHEDULE B UNIT(S) (23) SHIPPING WEIGHT (Kilograms) (24)

27. LICENSENO./LICENSE EXCEPTION SYMBOL/AUTHORIZATION 29. Duly authorized officer or employee

28. ECCN (When required)

The USPPI authorizes the forwarder named above to act as forwarding agent for exportcontrol and customs purposes.

Clear fields 1 to 19
Clear Fields 20 to 26

30. I certify that all statements made and all information contained herein are true and correct and that I have read
andunderstand the instructions for preparation of this document, set forth in the "Correct Way to Fill Out the Shipper’s Export Declaration." I understand that civil and criminal penalties, including...