Application for Allowance in Duties

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

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OMB No. 1651-0007

APPLICATION FOR ALLOWANCE IN DUTIES
Any data typed after screen scrolls will not print.

19 CFR 158.11, 158.13, 158.23
1. TO: (Port Director of CBP)

2. FROM: (Name and address of Importer or Agent)

3. ENTRY NO.

4. DATE

(mm/dd/yyyy)

5. APPLICATION FOR ALLOWANCE IN DUTY BECAUSE OF:
Destruction (Casualty)

A.

Damage

B.

Excessive moisture and impurities not usually found in or upon such or similar merchandise. (Landed weight or gauge in excess of that invoiced is in itself not adequate
evidence of excessive moisture or impurities.)

C.

Nonimportation of perishable merchandise. Goods to be segregated

Lost or stolen while in Public Stores

on pier

at our place of business

Complete columns 6, 7, 8, and 9 for Claims A and B, and columns 8 and 9 for Claim C.

INSTRUCTIONS: Columns 6 and 7 are self-explanatory. For column 8, the nature and normal content may be stated together, such as "2% moisture," or "No Sand," etc. When
normal content is based upon a standard which the applicant contends is recognized and required by traders in a particular commodity, state the approximate length of time
such standard has existed. For column 9, furnish results of laboratory test or other physical data obtained in support of this claim.
6.
MARKS AND
NUMBERS

7.
DESCRIPTION OF MERCHANDISE

10. IMPORTER

8.
DESCRIBE CASUALTY, NATURE OF IMPURITY
AND NORMAL CONTENT CONTENDED

11. OWNER/IMPORTER NUMBER

9.
LAB TEST RESULTS
(Attach Copy)

12. CARRIER

13. DATE, TIME, AND PLACE OF UNLOADING

14. COMPLETE APPLICABLE STATEMENT BELOW (Letters match those above)
I have personally inspected and examined the merchandise described and I hereby declare that same sustained damage above stated. The merchandise, to the best of my
knowledge and belief, was
Destroyed (Casualty)
Lost or stolen while in Public Stores

A.

B.

I have personally inspected and examined the merchandise described in the foregoing application and determine that the same contains excessive moisture, or other
impurities, not usually found in or upon such or similar merchandise, as indicated above. This claim is based upon the following facts, if any, ascertained by me or under my

C.

We request permission to segregate the damaged goods with the aggreement that all expenses in connection with the delivery under custody and the supervision of
segregation at our place of business will be borne by us, and will be paid promptly.

15. DATE OF FILING

(mm/dd/yyyy)

17. CBP ACTION
ACCEPTED

16. SIGNATURE AND TITLE OF APPLICANT/AGENT

18. DATE

(mm/dd/yyyy)

19. SIGNATURE AND TITLE OF CBP OFFICER

NOT
ACCEPTED

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 Protection. The form is used by United States importers to apply for a duty allowance due to damaged or defective imported
merchandise and by CBP to authorize such a duty allowance. It is required to obtain or retain a benefit. The estimated average burden associated with this collection of
information is 8 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimates 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 (1651-0007), Washington, DC 20503.

CBP Form 4315 (7-03)
Form Page

Any data typed after screen scrolls will not print.

CBP USE ONLY (Complete applicable parts)
(A) CLAIMS

Section 158.23, C.R.

DESCRIPTION OF DAMAGE SUSTAINED
Merchandise Examined

(B) CLAIMS

Section 158.13, C.R.
NATURE OF IMPURITY ON WHICH CLAIM IS BASED
Contains

Does not contain

impurities in excess of that usually found in or upon such or similar merchandise.

COMPLETE ITEMS (1), (2), AND (3)
1.

2.

MARKS AND NUMBERS

DESCRIPTION OF MERCHANDISE

3.
(A) Rate of damage or report as to loss or theft, or
(B) Percentage of excessive impurities

(If more space needed use separate sheet)
DATE OF REPORT

(mm/dd/yyyy)

SIGNATURE AND TITLE OF CBP OFFICIAL

(C) CLAIMS

Section 158.11, C. R.

Authorization is granted for the importer to segregate from the remainder of the shipment and repack under supervision
on pier
DATE

at his/her place of business

(mm/dd/yyyy)

that portion which arrived in bad condition.

SIGNATURE AND TITLE OF CBP OFFICIAL

The segregation and repacking was accomplished under continuous supervision, the segregated
portion, consisting of both merchandise and empty containers, was disposed of by:
DISPOSAL DATE

DATE

(mm/dd/yyyy

(mm/dd/yyyy)

NUMBER OF CRATES, BOXES, ETC.

MANNER OF DESTRUCTION

SIGNATURE AND TITLE OF CBP OFFICIAL

The contents of the merchandise totaled below were found to be entirely without commercial value and were presumptively without value at time of arrival.
DATE OF EXAMINATION (mm/dd/yyyy)

NUMBER OF CRATES, BOXES, ETC.

DATE

SIGNATURE AND TITLE OF CBP OFFICIAL

(mm/dd/yyyy)

CBP Form 4315 (7-03)(Back)
Form Page