Form BIS-6051P Report of Request for Restrictive Trade Practices - Mult

FORM BIS-6051P

U.S. DEPARTMENT OF COMMERCE
BUREAU OF INDUSTRY AND SECURITY

(REV 7-03)

THIS SPACE FOR BIS USE

REPORT OF REQUEST FOR RESTRICTIVE TRADE PRACTICE OR BOYCOTT
MULTIPLE TRANSACTIONS (Sheet No. 1)

A

(For reporting requests described in 769 of the Export Administration Regulations)
NOTICE OF RIGHT TO PROTECT CERTAIN INFORMATION FROM DISCLOSURE. The Export Administration Act permits you to protect from public disclosure information regarding the quantity, description,
and value of the commodities or technical data supplied in item 9 of this report and in any accompanying documents. If you do not claim this protection, all of the information in your report and in accompanying
documents will be made available for public inspection and copying. You can obtain this protection by certifying, in Item 5 of the report, that disclosure of the information regarding the quantity, description and value
of the commodities or technical data referred to above would place a United States company or individual involved in the report at a competitive disadvantage. If you make such a certification in Item 5, you may
remove information regarding the quantity, description, and value of the commodities or technical data supplied by you from Item 9 of the public inspection copy of the report form and from the public inspection copies
of the accompanying documents. The withholding of this information will be honored by the Department unless the Secretary determines that disclosure of the information would not place a United States company or
individual at a competitive disadvantage or tat it would be contrary to the national interest to withhold the information.

MONTH/YEAR

BATCH ____ ____ ____ ____

___ ___ ___ ___

This report is required by law (50 U.S.C. App. §2403-1a(b); P.L. 95-52; E.O. 12002; 15 CFR
Part 769). Failure to report can result both in criminal penalties, including fines or imprisonment,
and administrative sanctions.

INSTRUCTIONS: 1: This form may not include a transaction report that is filed late, nor indicate a decision on request other than those coded in item 4 below. 2. This form may be used to report on behalf of another United States person if all transactions apply to the person identified in item 2, but may not be
considered as a dual report on behalf of both persons identified in item 1a and Item 2. 3. Limit each report to 75 transactions or less. 4. Attach as many continuation sheets as needed. Enter sheet number and name of reporting firm on each continuation sheet (starting with Sheet No. 2). 5. List each transaction
across the continuation sheet, completing all items that apply. Use as many lines as necessary but separate transactions with a blank space or line. 6. Assemble original report form and accompanying documents as a unit, and submit intact and unaltered. 7. Assemble and submit the duplicate copy of report
form (marked Duplicate (Public Inspection Copy)) and additional copies of accompanying documents (marked with the legend “Public Inspection Copy.”) 8. If you certify, in item 5, that the disclosure of the information specified tere would cause competitive disadvantage, edit the “Public Inspection Copy” of the
documents submitted to exclude the specified information and remove the right hand portion of the Duplicate(Public Inspection Copy) of the continuation sheet(s) relating to Column 9. MULTIPLE TRANSACTIONS: Public reporting for this collection of information is estimated to average one hour per reported
request, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection o information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to Office of Administration, Bureau of Industry and Security, H3889, U.S. Department of Commerce, Washington, D.C. 20230; and to the Office of Management and Budget, Paperwork Reduction Project (0694-0012), Washington, D.C. 20503.

1a. Identify firm submitting this report:

Specify firm type:

Name:

□✔Exporter

□

Carrier

□

Bank

□

Insurer

□✔

□

Forwarder

□

Other

□

Address:
City:

State:

1b.

ZIP:

Country (if other than USA):
Telephone:
Firm: Identification No. (If known)

□

Check any applicable box:
Revision of a previous report (attach two copies of the
previously submitted report)

2.

If you are authorized to report and are reporting on behalf of another U.S.
person, identify that person (e.g. domestic subsidiary, controlled foreign
subsidiary, exporter, beneficiary):
Name:

Resubmission of a deficient report returned by BTR (attach
form letter that was returned with deficient report)

Address:
City:
Country (if other than USA):

Report on behalf of the person identified in item 2

Type of firm: (see list in item 1a)

State:

ZIP:

3. REQUESTING DOCUMENT CODES (use to code Column 6 of continuation sheet)
C
U

Request to carrier for blacklist certificate (submit two copies of blacklist certificate or transcript of request)
Unwritten, not otherwise provided for (make transcript of request and submit two copies)

L

Letter of credit

R

Requisition/purchase order/accepted contract/shipping instruction

B

Bid invitation/tender/proposal/trade opportunity

Q

Questionnaire (not related to a particular dollar value transaction)

9

Other written

}

Submit two copies of each document or relevant page in which the request appears.

4. DECISION ON REQUEST CODES (use to code Column 7 of continuation sheet)
R
T

Have not taken and will not take the action requested
Have taken or will take the action requested

5. Protection of certain information from disclosure: (Check appropriate boxes and sign below)

✔
□

I (we) certify that disclosure to the public of the information regarding quantity, description, and value of the commodities or technical data contained in:

□
□

Column 9 of the attached continuation sheets (If you check this box, be sure to remove column 9 from the Duplicate (Public Inspection Copy) of the continuation sheets.

Attached documents (If you check this box, be sure to edit the “Public Inspection Copy” of the documents submitted to exclude the specified information.) would place a United States person involved at a competitive disadvantage, and I (we) request that it be
kept confidential

✔
□

I (we) authorize public release of all information contained in the report and in any attached documents.

I (we) certify that all statements and information contained in this report are true and correct to the best of my (our) knowledge and belief.
Sign here in ink _________________________________________________________________________ Type or print __________________________________________________________________________________________ Date _______________________

Submit original and 1 copy to Office of Antiboycott Compliance, BIS, Room 6099C, U.S. Department of Commerce, Washington, D.C. 20230; Retain a copy for your records.