Form 3499 Application & Approval to Manipulate, Examine, Sample or

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
APPLICATION AND APPROVAL
TO MANIPULATE, EXAMINE, SAMPLE OR TRANSFER GOODS
1. GOODS CONSIGNED TO (Name)

2. GOODS EXPORTED FROM

Form Approved
OMB No. 1651-0006
Exp. 07-31-2009
3. PORT/PORT CODE AND DATE OF APPLICATION

4. LOCATION OF GOODS

5. CARRIER OR SHIP (Name)

6. BILL OF LADING OR CBP 7512 NO.

7. IS AREA BONDED?

8. ENTRY INFORMATION

Number:

19 CFR 19.8, 19.11, 158.43

YES

NO

Warehouse

Consumption

Date:

PERMISSION IS REQUESTED TO: (Describe the complete operation to be performed under CBP supervision on the goods listed below):

9. MARKS AND NUMBERS

10. DESCRIPTION

FOR CBP USE ONLY
11. MANIPULATED VALUE

12. SIGNATURE OF APPLICANT

APPROVED
13. DATE

14. SIGNATURE AND TITLE OF APPROVING CBP OFFICER

See Page 2 of form for Paperwork Reduction Act Notice. Customs and Border Protection Officers Report on Reverse

CBP Form 3499 (10/95)

CUSTOMS AND BORDER PROTECTION OFFICER'S REPORT

Date:

MANIPULATION COMPLETED AS REQUESTED: When goods are repacked the CBP (warehouse) officer will report
hereon the marks and numbers of packages repacked and the marks and numbers of packages and the weights or
guage of same after repacking.

(CBP Officer and Title)

PAPERWORK REDUCTION ACT NOTICE: The Paperwork Reduction 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 in order to carry out U.S. Customs and Border Protection laws of
the United States. This form is used by importers as an application to examine, sample, repack or transfer merchandise under CBP
supervision; as a request for manipulation of merchandise in a bonded warehouse; and as an application for abandonment or destruction of
merchandise in bond. It is required to obtain or retain a benefit. The estimated average burden associated with this collection of information
is 6 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 (1651-0006), Washington, DC 20503.
CBP Form 3499 (10/95)