CBP Form 214 Application for Foreign Trade Zone Admission and/or Stat

OMB No. 1651-0029

CENSUS USE ONLY

U.S. DEPARTMENT OF HOMELAND SECURITY

1. ZONE NO. AND LOCATION (Address)

Bureau of Customs and Border Protection
APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION

2. PORT CODE

19 CFR 146.22, 146.32, 146.35-146.37, 146.39-146.41, 146.44, 146.53, 146.66
3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

4. EXPORT DATE

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?
15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

16.
DESCRIPTION OF MERCHANDISE

17.
HTSUS NO.

YES
18.
QUANTITY
(HTSUS)

10. INWARD M'FEST NO.

NO
19.
GROSS
WEIGHT

20.
SEPARATE
VALUE & AGGR
CHGS.

21. HARBOR MAINTENANCE FEE (19 CFR 24.24)
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)

PRIVILEGED FOREIGN
(19 CFR 146.41)

ZONE RESTRICTED
(19 CFR 146.44)

DOMESTIC
(19 CFR 146.43)

24. APPLICANT FIRM NAME

25. BY (Signature)

26. TITLE

27. DATE

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

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

29. TITLE

30. DATE

32. TITLE

33. DATE

35. TITLE

36. DATE

PERMIT
PERMIT

Permission is hereby granted to 31. PORT DIRECTOR OF CBP: BY (Signature)
transfer the above merchandise
into the Zone.
The above merchandise has been 34. PORT DIRECTOR OF CBP: BY (Signature)
granted the requested status.
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. TITLE

40. STATION

41. DATE

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

43. CARTMAN

44. CHL NO.

45. DATE

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
47. FOR THE FTZ OPERATOR (Signature)
ZONE
(See back of form for Paperwork Reduction Act Notice.)

48. TITLE

Previous Editions are Obsolete

49. DATE

CBP Form 214 (02/96)

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act.
We ask for the information in order to carry out the laws and regulations administered by the Bureau of Customs
and Border Protection 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 15 minutes per respondent and 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 214 (02/96)(Back)