Form 3171 Application-Permit-Special License Unlading/Lading, Over

Form Approved OMB No. 1651-0005
CBP USE ONLY

U.S. DEPARTMENT OF HOMELAND SECURITY

Bureau of Customs and Border Protection

APPROVED
No.

APPLICATION-PERMIT-SPECIAL LICENSE
UNLADING-LADING-OVERTIME SERVICES

Date/Time
Signature of CBP Officer

19 CFR 4.10, 4.30, 4.37, 4.39, 4.91, 10.60, 24.16,
122.29, 122.38, 123.8, 146.32, 146.34
1. Name of Vessel, Vehicle or Aircraft

2. Port

3. Flag

5. Name/Phone No. of Agent

4. Name and Nationality of Owner/Operator

6. Arriving from
(Port Name and Country)

7. Date/Time of Arrival

8. Locations (Dock/Terminal)*
Day Phone

Night Phone
9. Application is made for a permit for the operations indicated:
(1) To unlade merchandise (intended to be unladen at this port, as shown by the manifest), baggage or passengers. To discharge ballast, and to land
''in bond'' merchandise. (Sec. 551, Tariff Act of 1930).
(2) To land supplies, ship's stores, sea stores, or equipment not to be reladen, subject, however, to free or duty-paid entry (Sec. 446, Tariff Act of
1930).
(3) To lade merchandise or baggage requiring CBP supervision.
(4) To land and release for repair, adjustment, or refilling and to relade under CBP supervision articles of carrier's equipment. (Articles to be listed
reverse side hereof showing date and hour of unlading and relading.) The undersigned certifies the articles listed on the reverse hereof for
release under this term is to be landed only for the purpose mentioned in this item and will be reladen on this carrier.
(5) Other
10. Itinerary of Vessel/Aircraft (show port country and departure dates for entire voyage including U.S. itinerary)*

11. TYPE OF CARGO:

Container
Break Bulk
Bulk
Other (Specify)
12. List all carriers, including carriers sharing or chartering space onboard the vessel and check the box that describes how the carrier presented the cargo
manifest.*

SCAC

AMS

CBP 1302

Paperless

SCAC

AMS

CBP 1302

Paperless

13. Application is made for a special license for overtime services of CBP officers and employees for:
Entrance, Clearance

Unlading, lading, etc.
at

on
(Date)

or

Other:
Per supplemental oral request

(Time)

14. Bond No.

15. Application is made for a Term Permit and Special License

16. Principal on Bond

From:
17. Surety Company Code

20. Importer Number
(Party to be billed; show hyphens)

To:
18. Amount of Bond

19. Date of Bond

21. Address of Agent
22. Signature

23. Date

This PERMIT is not valid until properly lodged with a CBP officer at the point of discharge and all operations indicated therein are performed under
CBP supervision.
*use back for additional space; (Instructions and Paperwork Reduction Act Notice on reverse)
CBP Form 3171 (01/02)

CONTINUED FROM ITEM #9 (4): RECORD OF ARTICLES RELEASED AND RELADEN
RELADEN

UNLADEN AND RELEASED
Date

Time

Released to

Description of Articles
Signature

Company

Insp. Badge
#

Time

Date

Insp. Badge
#

Continued from # 8 - additional Locations:

Continued from # 9 (5) - Other:

Continued from # 10 - additional Itinerary of Vessel:

Continued from # 12 - additional SCAC Codes:

SCAC

AMS

CBP 1302

Paperless

SCAC

AMS

CBP 1302

Paperless

INSTRUCTIONS
CBP Form 3171 shall be filed in duplicate. (When a term permit is requested, additional copies may be required for local purposes). Items shall be
completed as follows:
1.

Name or number of vessel, vehicle, or aircraft (On term permit
''Not Applicable.'')

10.

Show port, country and sailing dates for the itinerary of the
vessel/aircraft, including U.S. itinerary.

2.

Port at which application is filed.

11.

Check the appropriate box/boxes.

3.

Flag of vessel.

12.

4.

Name of shipping company, airlines etc., which owns or
operates the vessel, vehicle or aircraft and their nationality.

List all carriers, including carriers sharing or chartering space
onboard the vessel and check the box that describes how the
carrier presented the cargo manifest.

5.

Name and day/night phone numbers of party filing application.

13.

6.

Name of port or place and country from which a vessel, vehicle,
or aircraft is arriving. (On Term Permit show ''Not applicable.'')

Indicate purpose for which services are requested and date and
time. (If date and time are not known, check "per supplemental
oral request.")

7.

Give the date of arrival or expected arrival when request covers
a specific vessel, vehicle, or aircraft.

14.

Self-Explanatory.

15.

When requesting a term permit, show dates or period to be
covered.

8.
9.

List all places of lading, unlading, etc. If request is for overtime
services only state where services are to be performed.

16-21. Self-Explanatory.

Check appropriate items.

22-23. Signature and date of party submitting request.

PAPER REDUCTION ACT NOTICE: The Paperwork Reduction Act says we must tell you why we are collecting this information, how we will use it, and whether you
have to give it to us. We ask for the information to carry out the Customs Service laws of the United States. This form is used by carriers to request specific CBP services
relating to the lading or unlading of merchandise and by CBP to authorize requested activities. It is also used to permit and control various statutes. Another major use of this
form is to request CBP services during other than regular hours of service. It is mandatory.
Statement Required by 5 CFR 1320.21: The estimated average burden associated with this collection of information is 8 minutes per respondent or recordkeeper depending
on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to Bureau of Customs
and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0005),
Washington, DC 20503.

CBP Form 3171 (Back)(01/02)