Form 4315 Application for Allowance in Duties

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0007
Exp. 02-28-2013

U.S. Customs and Border Protection

APPLICATION FOR ALLOWANCE IN DUTIES
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

5. APPLICATION FOR ALLOWANCE IN DUTY BECAUSE OF:
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.)
Nonimportation of perishable merchandise. Goods to be segregated
on pier
at our place of business

C.

Lost or stolen while in Public

Destruction (Casualty)

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
Lost or stolen while in Public Stores
Destroyed (Casualty)

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 direction.

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

16. SIGNATURE AND TITLE OF APPLICANT/AGENT

17. CBP ACTION

18. DATE
19. SIGNATURE AND TITLE OF CBP OFFICER
NOT
ACCEPTED
ACCEPTED
PAPERWORK REDUCTION ACT: 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 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 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 (1651-0007), Washington, DC 20503.

CBP Form 4315 (09/98)

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

Section 158.23, C.R.
Merchandise Examined

DESCRIPTION OF DAMAGE SUSTAINED

(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.
MARKS AND NUMBERS

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

2.
DESCRIPTION OF MERCHANDISE

(If more space needed use separate sheet)

DATE OF REPORT

SIGNATURE AND TITLE OF CBP OFFICIAL

Section 158.11, C. R.
(C) CLAIMS
Authorization is granted for the importer to segregate from the remainder of the shipment and repack under supervision
on pier

at his/her place of business

DATE

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

NUMBER OF CRATES, BOXES, ETC.

DATE

SIGNATURE AND TITLE OF CBP OFFICIAL

MANNER OF DESTRUCTION

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

NUMBER OF CRATES, BOXES, ETC.

DATE

SIGNATURE AND TITLE OF CBP OFFICIAL

CBP Form 4315 (09/98)(Back)