CBP Form 214a

OMB No. 1651-0029

CENSUS USE ONLY

U.S. DEPARTMENT OF HOMELAND SECURITY
Bureau of Customs and Border Protection

APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION
Any data typed after screen scrolls will not
19 CFR 146.32, 146.40
4. EXPORT DATE

3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

1. ZONE NO. AND LOCATION (Address)

2. PORT CODE

5. IMPORT DATE

6. ZONE ADMISSION NO.

7. U.S. PORT OF UNLADING

8. FOREIGN PORT OF LADING

9. BILL OF LADING/AWB NO.

11. INBOND CARRIER

12. I.T. NO. AND DATE

13. I.T. FROM (Port)

14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT?
16.
DESCRIPTION OF MERCHANDISE

15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

YES

17.
HTSUS NO.

10. INWARD M'FEST NO.

NO
19.
GROSS
WEIGHT

18.
QUANTITY
(HTSUS)

21. HARBOR MAINTENANCE FEE (19 CFR

20.
SEPARATE
VALUE & AGGR
CHGS.

U.

22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above merchandise is not
prohibited entry into the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended, and section 146.31, Customs Regulations.
23. I hereby apply for the status designation indicated:
NONPRIVILEGED FOREIGN
(19 CFR 146.42)
24. APPLICANT FIRM NAME

(This is a mandatory field)

F.T.Z. AGREES TO RECEIVE
MERCHANDISE INTO THE ZONE

PRIVILEGED FOREIGN
(19 CFR 146.41)

ZONE RESTRICTED
(19 CFR 146.44)

DOMESTIC
(19 CFR 146.43)

25. BY (Signature)

26. TITLE

27. DATE

(mm/dd/yyyy)

28. FOR THE F.T.Z. OPERATOR (Signature)

29. TITLE

30. DATE

(mm/dd/yyyy)

Permission is hereby granted to
transfer the above merchandise
into the Zone.

31. PORT DIRECTOR OF CBP: BY (Signature)

32.

33. DATE

(mm/dd/yyyy)

PERMIT

The above merchandise has
been granted the requested

34. PORT DIRECTOR OF CBP: BY (Signature)

35.

36. DATE

(mm/dd/yyyy)

PERMIT

37. The goods described herein are authorized to be transferred:

PERMIT
TO
TRANSFER

without exception

except as noted below

38. CBP OFFICER AT STATION (Signature)

39.

40. STATION

41. DATE

(mm/dd/yyyy)

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature)

43. CARTMAN

44. CHL NO.

45. DATE

(mm/dd/yyyy)

49. DATE

(mm/dd/yyyy)

46. To the Port Director of CBP: The above merchandise was received at the Zone on the date shown except as noted below:

FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT
ZONE
47. FOR THE FTZ OPERATOR (Signature)

48. TITLE

STATISTICAL COPY

CBP Form 214A (6-03)

Paperwork Reduction Act Notice: This request is in accordance with the Paperwork Reduction Act of 1995.
We ask for the information in order to carry out the laws and regulations administered by the Bureau of
Customs and Border Protextion and Foreign-Trade Zones Board. These regulations and forms apply to
importers/exporters to ensure that they are complying with these laws. It is mandatory. The estimated
average burden associated with this collection of information is 17 minutes per respondent 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
(1651-0029), Washington, DC 20503.
CBP Form 214A (6-03)