Agriculture Wool Apparel Manufacturers Trust Fund

For 9902.51.11 OMB No.: 0551-0045 Expires 09/30/2018



APPLICATION FOR 2018 MONETIZED TRQ PAYMENTS

MANUFACTURERS OF MEN’S & BOYS’ WORSTED WOOL SUITS, SUIT-TYPE JACKETS AND TROUSERS

Please check if garments are cut and sewn in your own plants.

and/or

Please check if garments were cut and sewn by a contractor and you had title to the fabric.

Note: Data based on microns.

Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the matters set out in the application, certify that the information contained herein is complete and accurate, signed and sworn before a Notary Public, and acknowledging that false representations to a federal agency may result in criminal penalties under federal law.

If data provided is to be treated as Business Confidential, please indicate prominently across top of form.

Data for January-December 2017

Signature of Representative

Date

Signature of Notary

Date

	M&B Worsted Wool Suits of 85% or More by Weight Wool		M&B Worsted Wool Suit-Type Jackets of 85% or More by Weight Wool		M&B Worsted Wool Trousers of 85% or More by Weight Wool
			Greater than 18.5 Microns
Quantity and Value	Units	($)	Units	($)	Units	($)
Period	January-December 2017		January-December 2017		January-December 2017
Production (fob plant)						
Using Imported Fabric
Names and Addresses of Plants Producing					
Contractors and Locations of Plants					

Company Name:	_______________________	Contact Name:	______________________ 
Company Address:	_______________________ 	Contact Address:	______________________ 
	_______________________ 		______________________ 
	_______________________ 		______________________ 
Company Federal Tax		Contact Telephone Number:		________________ 
Identification Number:	_______________________ 	Contact Email Address:		________________ 

AVERAGE FIBER DIAMETER GREATER THAN 18.5 MICRONS (HTS 9902.51.11)

For listing additional plants and/or contractors, go to the next page.

Public reporting for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent allowed under the Freedom of Information Act. Notwithstanding any other provision of the law, no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless the collection of information displays a current valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Import Policies and Export Reporting Division at: [email protected]

Continued on Next Page

For 9902.51.11 OMB No.: 0551-0045 Expires 09/30/2018 Continuation Sheet

Total Direct ($):___________________________ Total Indirect ($):____________________________

	Worsted Wool Fabric of 85% or More by Weight Wool For M&B Suits		Worsted Wool Fabric of 85% or More by Weight Wool For M&B Suit-Type Jackets		Worsted Wool Fabric of 85% or More by Weight Wool For M&B Trousers
Purchases of	Greater than 18.5 Microns		Greater than 18.5 Microns		Greater than 18.5 Microns
Quantity and Value (Value = Customs Entered Value*)	Square Meters	($)	Square Meters	($)	Square Meters	($)
Period	January-December 2017		January-December 2017		January-December 2017
Imports (Value= D:						
transaction value*) ID:

*Nondirect importers enter the value that the material was purchased.

	M&B Worsted Wool Suits of 85% or More by Weight Wool	M&B Worsted Wool Suit-Type Jackets of 85% or More by Weight Wool	M&B Worsted Wool Trousers of 85% or More by Weight Wool
		Greater than 18.5 Microns
Names and Addresses of Plants Producing			
Names and Addresses of Plants Producing			
Names and Addresses of Plants Producing			

E-Mail completed and notarized form to: [email protected]

NOTE: Do not report imported wool fabric under Subheading 5112.19.95 from the following countries: Bahrain (BH); Canada (CA); Chile (CL); Israel (IL); Jordan (JO); South Korea (KR); Morocco (MA); Mexico (MX); Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua, and the Dominican Republic (P); Panama (PA); Peru (PE); and Singapore (SG). Do not report imported wool fabric under Subheading 5112.11.60 from the following countries: Bahrain (BH); Canada (CA); Chile (CL); Columbia (CO); Israel (IL); Jordan (JO); South Korea (KR); Morocco (MA); Mexico (MX); Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua, and the Dominican Republic (P); Panama (PA); Peru (PE); and Singapore (SG).

	M&B Worsted Wool Suits of 85% or More by Weight Wool	M&B Worsted Wool Suit-Type Jackets of 85% or More by Weight Wool	M&B Worsted Wool Trousers of 85% or More by Weight Wool
		Greater than 18.5 Microns
Contractors and Locations of Plants			
Contractors and Locations of Plants			
Contractors and Locations of Plants			

If additional space for listing plants and/or contractors is needed, use this page again after printing or attach a blank sheet of paper with the requested information.

List Additional Contractors Below

List Additional Plants Below