Form CBP-26 Report of Diversion

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0025
Exp. 08-31-2008

U.S. Customs and Border Protection
REPORT OF DIVERSION
19 CFR 4.91 (a) and (b)
1. PORT WHICH GRANTED CLEARANCE OR PERMIT TO PROCEED

2. NATIONALITY (American or Foreign)

3. NAME OF VESSEL

4. RIG

5. DATE

CBP PORT DIRECTOR

6. NAME OF PORT TO WHICH CLEARED

7. DATE OF CLEARANCE

8. ACTUAL/EXPECTED PORT OF ARRIVAL

9. DATE OF ARRIVAL

PLEASE NOTIFY THE PORT DIRECTOR AT THE PORT OF ARRIVAL. (The port director will act only when timely notified under
section 4.91(a), and 4.91(b), of the Customs Regulations)
AND/OR
GRANT RELIEF FROM ANY PENALTY TO WHICH THE MASTER OWNER OR AGENT MAY BE LIABLE UNDER 46 U.S.C. 91 CR
19 U.S.C. 1445.
10. REASONS

11. REPORT SUBMITTED BY

13. DATE

12. TITLE (Owner, Master, or Agent)

14. PENALTY CASE NUMBER

15. AMOUNT OF PENALTY

$

Port
16. PENALTY ASSESSED AGAINST

17. SECTION OF LAW VIOLATED

18. RECOMMEND THAT THE PENALTY BE
Remitted

Mitigated to

$

19. CBP PORT DIRECTOR BY
21. PURSUANT TO THE AUTHORITY CONTAINED IN 19 U.S.C. 1618 OR 46 U.S.C. 7, THE ABOVE PENALTY IS
Remitted
Mitigated to
22. SIGNATURE OF CBP PORT DIRECTOR BY

20. DATE

$
23. DATE

NOTE: No notice of remission will be furnished. If no notice is received within 30 days, the petitioner may presume that penalty has been remitted.
PAPERWORK REDUCTION ACT NOTICE: This is in accordance with the Paperwork Reduction Act. The information to be provided is submitted by vessel
owners, masters or agents when requesting a diversion of the vessel or to petition for relief from penalties as a result of an unlawful diversion or both.
Completion of this form is mandatory. It is used to carry out the Customs and Border Protection laws of the United States. The estimated average burden
associated with this collection of information is 5 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 U.S. Customs and Border Protection, Information Services Branch,
Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0025), Washington, DC 20503.

CBP Form 26 (03/00)