Form 5106 Create/Update Importer Identity Form

DEPARTMENT OF HOMELAND SECURITY

Approved OMB NO. 1651-0064
Exp. 05-31-2016

U.S. Customs and Border Protection

CREATE/UPDATE IMPORTER IDENTITY FORM
19 CFR 24.5

As the importer, consignee, or other party listed in block 1, you are responsible for the validity of the information provided in this
document. Any Customs Broker or third party who is submitting the information on your behalf is only obligated to convey this
information to Customs and Border Protection (CBP).
TYPE OF ACTION (Mark all applicable):

Notification of identification number

1. NAME AND IDENTIFICATION NUMBER
1A. Importer/Business/Private Party Name:
1C.

DIV

AKA

Change of name*

Change of address*

1B. Internal Revenue Service (IRS) number/Social Security Number (SSN):
1D. DIV/AKA/DBA Name:

DBA

1E.

I wish to be assigned a CBP Number. Check here if requesting a CBP-assigned number and indicate reason(s).
Check all reasons that apply.
I have no IRS
I have no Social
I have not applied for
I am not a
I have a SSN, but wish to use a
Number
Security Number
an IRS number or SSN
U.S. Resident
CBP-Assigned Number on all my
entry documents
1F. CBP-Assigned Number:
1G. Type of Company:
U.S. Government

Corporation
Partnership
LLC
Sole Proprietorship
State/Local Government
Foreign Government

Individual

1-5 per year
1H. If you are an importer, how many entries do you plan on filing in a year? Please select from the following:
5-25 per year
25 or more per year
infrequent personal shipments, or
I do not intend to import.
1I. How will the identification number be utilized? Please select all options that will apply:
Consignee/Ultimate Consignee
Drawback Claimant
Refunds/Bills, or
1J. Program Code 1:

1K. Program Code 2:

1L. Program Code 3:

Importer of Record
Other
1M. Program Code 4:

2. ADDRESS INFORMATION
2A. MAILING ADDRESS
Street Address 1:

City:

State/Province:

Street Address 2:

Zip Code:

Country ISO Code:

Corporate Office
Warehouse
Is the address in 2A, a
Residence
Business Service Center
Post Office Box or
Other - Explain:

Retail Location

Office Building

2B. PHYSICAL LOCATION ADDRESS
Street Address 1:

City:

State/Province:

Street Address 2:

Zip Code:

Country ISO Code:

Is the address in 2B, a
Other - Explain:

Residence

2C. Phone number:

Corporate Office

Extension:

2E. Email address:

Warehouse

Retail Location

Office Building or

2D. Fax number:
2F. Website:

3. COMPANY INFORMATION
3A. Provide a brief business description:
3B. Provide the 6-digit North American Industry Classification System (NAICS) code for this business:
3C. Provide the D-U-N-S Number for the Importer:
3D. If you are also a broker/self-filer, supply the filer code that will be used when conducting business with CBP:
CBP Form 5106 (2/16)

3E. Year established:
3F. List the names and Internal Revenue Service (IRS) employer identification, Social Security or CBP-assigned numbers for current
or previous related business entities.
Related Business
Name of Business Entities
IRS/SSN/CBP Assigned Number
Current

Previous

Current

Previous

Current

Previous

3G. Primary Banking Institution:

(Name)

(Bank Routing Number)

(City)

(State)

(Country ISO Code)

3H. Certificate or Articles of Incorporation - (Locator I.D.)
3I. Certificate or Articles of Incorporation – (Reference Number)
3J. Business Structure/Beneficial Owner/Company Officers - The officers listed in this section must have importing and financial
business knowledge of the company listed in section 1 of this form and must have legal authority to make decisions on behalf of the
company listed in section 1. *Optional, please see Instructions.
Company Position Title:
Name (First, Middle, Last):
Direct Phone Number:
Social Security Number:
Passport Type:

Direct Email:

Extension:
Passport Number:

Regular

Official

Country of Issuance:
Diplomatic

Company Position Title:

Name (First, Middle, Last):

Direct Phone Number:

Extension:

Social Security Number:
Passport Type:

Passport Number:

Regular

Official

Country of Issuance:
Diplomatic

Name (First, Middle, Last):

Direct Phone Number:

Extension:

Passport Type:

Passport Number:

Regular

Official

Diplomatic

Direct Phone Number:

Extension:

Passport Type:

Regular

Official

Passport Card

Country of Issuance:

Name (First, Middle, Last):

Passport Number:

Passport Expiration Date:

Direct Email:

Company Position Title:

Social Security Number:

Passport Card

Direct Email:

Company Position Title:

Social Security Number:

Passport Expiration Date:

Passport Expiration Date:

Passport Card

Direct Email:
Country of Issuance:
Diplomatic

Passport Expiration Date:

Passport Card

4. CERTIFICATION
By my signature below, I certify that, to the best of my knowledge and belief, all of the information included in this document is true,
correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this
5106 document, I may be fined or imprisoned (18 U.S.C. § 1001).
Printed or Typed Full Name and Title:
Signature:
Telephone Number:

Date:

Broker Name:

Telephone Number:
CBP Form 5106 (2/16)

PAPERWORK REDUCTION ACT STATEMENT: An agency may not conduct or sponsor an information collection and a person is
not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control
number for this collection is 1651-0064. The estimated average time to complete this application is 45 minutes. The obligation to
respond is required to obtain a benefit. If you have any comments regarding the burden estimate you can write to U.S. Customs and
Border Protection, Office of International Trade, Regulations and Rulings, 90 K Street NE, Washington DC 20229-1177.
PRIVACY ACT STATEMENT: Pursuant to the requirements of Public Law 93-579 (Privacy Act of 1974), notice is hereby given that:
19 CFR 24.5 authorizes the disclosure of Social Security numbers (SSN) on the CBP Form 5106, and implements CBP's authority to
collect the taxpayer identification number and SSN as provided for in 31 U.S.C. 7701; the principal purpose for disclosure of the
Social Security number is to identify the individuals conducting business with CBP to assist in regulatory compliance and
investigations, and administrative or judicial proceedings; the information collected may be provided to those officers and employees
of CBP and any constituent unit of the Department of Homeland Security who have a need to know the information in the
performance of their duties; also, the records may be referred to any federal, state, local tribal, territorial, or foreign agency for whom
CBP determines may assist in the enforcement of criminal or civil laws, or assist in intelligence or counter-intelligence, or breach
notification, or for the compilation of foreign trade statistics; and failure to provide the required information will result in the denial of
an importer of record number, the requirement to use a separate party for transactions, and may impact or delay the importation of
shipments in international trade.
TYPE OF ACTION (CBP Form 5106 QR Code can be scanned to link this form to your smartphone or mobile operating device.)
Notification of Identification Number - Check this box if this is your first request for services with CBP, or if your current Importer
Number is inactive and you wish to activate this number.
Change Name - Check this box if the Importer Number is on file but there is a change in the name.
Change of Address - Check this box if the Importer Number is on file but there is a change in the address.
BLOCK 1 - NAME AND IDENTIFICATION NUMBER
1A - Importer/Business/Private Name - Please indicate the name of the company or individual who will be importing or seeking
service or payment. If you are submitting this document as a consignee to the import transaction, sections 1 and 2 must be filled out
completely.
1B - IRS/SSN - Complete this block if you are assigned an Internal Revenue Service (IRS) employer identification number or Social
Security Number (SSN). If neither an IRS employer identification number nor a Social Security Number (SSN) has been assigned,
the word “NONE” shall be written in 1B. The SSN should belong to the principal or owner of the company.
1C - DIV/AKA/DBA - Complete this block if an importer is a division of another company (DIV), is also known under another name
(AKA), or conducts business under another name (DBA).
1D - Complete this block only if Block 1C is used.
1E - Request CBP-Assigned Number - Complete this block if you have neither an IRS employer identification number nor a SSN
and you require a CBP-assigned number, or, you choose to use a CBP-assigned number in lieu of your SSN. If you have an IRS
employer identification number at the time you submit this form, that number will automatically become your importer identification
number and no CBP-assigned number will be issued. PLEASE NOTE: A CBP-assigned number is for CBP use only and does not
replace listing a SSN or IRS employer identification number on this form. If you have elected to request a CBP Assigned Number in
lieu of your SSN, you must provide your SSN in section 3J of this form. In general, a CBP- assigned number will be issued to foreign
businesses or individuals, provided no IRS employer identification number or SSN exists for the requester. A requester can choose
to keep using the CBP-assigned number even if the individual subsequently acquires a SSN. If block 1E is completed, CBP will
issue an assigned number and inform the requester. This identification number will be used for all future CBP transactions when an
identification number is required. If an IRS employer identification number, a Social Security Number, or both, are obtained after an
identification number has been assigned by CBP, a new CBP Form 5106 form shall not be filed unless requested by CBP.
1F - CBP-Assigned Number - Complete this block if you have already been assigned a CBP-Assigned Number, and there is a
requested change in Block "Type of Action".
1G - Type of Company- Please select the description that accurately describes your company. A Limited Liability Company (LLC) is
not a corporation; it is a legal form of company that provides limited liability to its owners.
1H - Provide an estimate of the number of entries that will be imported into the U.S. in one year, if you are an importer of record.
1I - Check the boxes which will indicate how the name and identification number will be utilized. If the role of the party is not listed,
you can select “Other” and then list the specific role for the party. (ex., Transportation carrier, Licensed Customs Brokerage Firm,
Container Freight Station, Commercial Warehouse/Foreign Trade Zone Operator, Container Examination Station or Deliver to Party).
1J thru 1M - If you are currently an active participant in a CBP Partnership Program(s), please provide the program code in Block
1J thru Block 1M of the revised CBP Form 5106 and the information that is contained in Section 3 of the revised CBP Form will not
be required. (ex., Customs Trade Partnership Against Terrorism - CTPAT, Importer Self-Assessment - ISA)
BLOCK 2 - ADDRESS INFORMATION
2A - MAILING ADDRESS (Mailing Address for the named business entity or individual referenced in section 1)
Street Address 1 - This block must always be completed. It may or may not be the physical location. Insert a post office box number
or a street number representing the first line of the mailing address. For a U.S. or Canadian mailing address, additional mailing
address information may be inserted. If a P.O. box number is given for the mailing address, a second address (physical location)
must be provided in 2B.
CBP Form 5106 (2/16)

Street Address 2 - If applicable, this block must always be completed with the apartment, suite, floor, and/or room number.
City - Insert the city name of the importer's mailing address.
State/Province - For a U.S. mailing address, insert a valid 2-position alphabetic U.S. state postal code. For a Canadian mailing
address, insert a 2-character alphabetic code representing the province of the importer's mailing address.
Zip Code - For a U.S. mailing address, insert a 5 or 9-digit numeric ZIP code as established by the U.S. Postal Service. For a
Canadian mailing address, insert a Canadian postal routing code. For a Mexican mailing address, leave blank. For all other foreign
mailing addresses, a postal routing code may be inserted.
Country ISO Code - For a U.S. mailing address, leave blank. For any foreign mailing address, including Canada and Mexico, insert
a 2-character alphabetic International Standards Organization (ISO) code representing the country.
Type of Address - Check the box that describes this address.
2B - PHYSICAL LOCATION ADDRESS - (Please provide the address that is associated with the business or the individual.
This address cannot be a P.O. Box, Business Service Center, etc. The address associated with the business can be the
principal's home address.)
Street Address 1- If the place of business is the same as the mailing address, leave blank. If different from the mailing address,
insert the company's business address in this space. A second address representing the company's place of business is to be
provided if the mailing address is a post office box or drawer.
Street Address 2 - If applicable, this block must always be completed with the apartment, suite, floor, and/or room number.
City - Insert the city name for the business address.
State/Province - For a U.S. address, insert a 2-character alphabetic U.S. state postal code. For a Canadian address, insert a 2character alphabetic code representing the province of the importer's business address.
Zip Code - For a U.S. business address, insert a 5 or 9-digit numeric ZIP code as established by the U.S. Postal Service. For a
Canadian address, insert a Canadian postal routing code. For a Mexican address, leave blank. For all other foreign addresses, a
postal routing code may be inserted.
Country ISO Code - For a U.S. address, leave blank. For any foreign address, including Canada and Mexico, insert a 2-character
alphabetic ISO code representing the country.
Type of Address - Check the box which describes this address.
2C - Phone Number - The phone number and extension
2E - E-mail Address - The e-mail.

2D - Fax Number - The fax number.
2F - Website - The website.

BLOCK 3 - COMPANY INFORMATION Company information is the named business entity referenced in section 1; all of the
requested information is required if available. Providing the Personally Identifiable Information in section 3J (i.e. Social Security
Number and Passport information) is optional unless in Block 1E, the filer has checked: "I have a SSN, but wish to use a CBPAssigned Number on all my entry documents." In this instance a SSN must be provided in 3J, as apropriate.The absence of this
information will affect CBP's ability to fully understand the level of risk on subsequent transactions and could result in the delay of
cargo release or the processing of a refund.
3A - Provide a brief description of your business.
3B - Complete this field if you know the North American Industry Classification System (NAICS) code as defined by the Department
Of Commerce. Provide your 6-digit NAICS code.
3C - If available, please provide the Dun & Bradstreet Number for the name that was presented in section 1.
3D - If you are an importer who is a self-filer and are using your own filer code, or a broker who also has maintained an identification
number, please provide the filer code that you will be using to conduct business with CBP.
3E - Indicate the year in which your company was established.
3F - Related Businesses Information - List the name and IRS employer identification number, Social Security Number or CBP
assigned number for each related business and indicate if it is a current or previous related business.
3G - Indicate the primary banking information for the company that is listed in section 1.
3H - Certificate or Articles of Incorporation - Provide the 2-digit State or insert a 2-character alphabetic ISO code representing the
country in which the articles of incorporation for the business were filed. (if applicable)
3I - Certificate or Articles of Incorporation - Provide the file, reference, entity, issuance or unique identifying number for the certificate
or articles of incorporation or the foreign articles of incorporation. (if applicable)
3J - Business Structure/Beneficial Owner/Company Officer - Please provide the requested information for Beneficial Owner/
Company Officer of the Corporation or the LLC that is listed in section 1. The Beneficial Owner is any individual or group of
individuals that, either directly or indirectly, has the power to vote or influence the transaction decisions regarding a specific security
or one who has the benefits of ownership of a Security (finance) or property and yet does not nominally own the asset itself.
Beneficial Owner/Company Officers who have importing and financial business knowledge of the company listed in section 1 and the
legal authority to make decisions on behalf of the company listed in section 1 with respect to that knowledge. The names of each
Beneficial Owner/Company Officer that is listed in this section are required fields. Please note, however, that the Social Security
Number or the Passport Number/Country of issuance ISO code/Passport Expiration Date/Passport Type, in the absence of a SSN,
are optional in this section.
CBP Form 5106 (2/16)