Form 3-200-22 Application - Import of Sport-Hunted Bontebok Trophies f

FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

IMPORT OF SPORT-HUNTED BONTEBOK TROPHIES FROM SOUTH AFRICA
☐New

☐Reissue/Renew ☐Amendment

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C.**
A. Complete if applying as an individual
1.a. Last name
2 Date of birth
(mm/dd/yyyy)

5.a. Telephone number

1.b. First name
5.b. Alternate telephone
number

1.c. Middle name or initial

1.d. Suffix

6. E-mail address

B. Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution
1.b. Doing business as (dba)
2. Tax identification no.

3.a. Description of business, agency, Tribe, or institution

4.a. Principal officer (P.O.) last name 4.b. P.O. first name

4.c. P.O. middle initial

5. Primary contact name

6. Primary e-mail address

7.a. Business telephone number

7.b. Alternate phone no.

3.b. Website URL (if applicable)
4.b. P.O. Title

8.a. Primary contact telephone no.

C. All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City

1.c. State

1.d. Zip code/Postal code

1.e. County/Province

1.f. Country

2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)
2.b. City

D.

2.c. State

2.d. Zip code/Postal code

2.e. County/Province

2.f. Country

All applicants MUST complete
1. Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, a nonrefundable processing fee (see the fee
schedule). Federal, Tribal, State, and local government agencies, and those acting on behalf of such agencies, are exempt from the
processing fee – attach documentation of fee exempt status as outlined in instructions. (50 CFR 13.11(d))
2.
3.

If you are requesting a reissue/renew/amendment, what is your permit/file number?
Certification: I hereby certify that I have read and am familiar with the regulations contained in Title 50, Part 13 of the Code of Federal
Regulations and the other applicable parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in this
application for a permit is complete and accurate to the best of my knowledge and belief. I understand that any false statement herein
may subject me to the criminal penalties of 18 U.S.C. 1001.

The individual/principal officer of the business must print and sign the application. (No photocopied or stamped signatures)

Date (mm/dd/yyyy)

** Click here for additional instructions on completing the above form (link to instruction page). See the last page for information on the Privacy Act,
Paperwork Reduction Act, Estimated Burden, and Freedom of Information Act aspects of this application form.
Mail your application(s) to Division of Management Authority, Branch of Permits, MS:IA 5275 Leesburg Pike, Falls Church, VA 22041-3803.
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FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

IMPORT OF SPORT-HUNTED BONTEBOK TROPHIES from South Africa
Note 1: If you hold an import permit for trophy/trophies that you did not use, please return the unused original permit to
the address on page one.
Note 2: If you are requesting reissuance of a permit because you have taken a trophy, but were unable to import it prior to
the expiration of the permit, please use the renewal form (3-200-52) and return your original permit with that form.
Note 3: The bontebok is listed as endangered under the Endangered Species Act. Applications for endangered species
permits must be published in the Federal Register for a 30-day public comment period. Allow at least 90 days for
the application to be processed.
Note 4: This application can only be used if you have hunted/will be hunting in South Africa. If you have or will be hunting
in a different country, please use form 3-200-20.
Note 5: Sport-hunted trophy is defined at 50 CFR 23.74 as follows: Sport-hunted trophy means a whole dead animal or a
readily recognizable part or derivative of an animal specifically identified on the accompanying CITES document
that meets the following criteria:
• Is raw, processed, or manufactured;
• Was legally obtained by the hunter through hunting for his or her personal use;
• Is being imported, exported, or re-exported by or on behalf of the hunter as part of the transfer from its country of
origin ultimately to the hunter's country of usual residence; and
• Includes worked, manufactured, or handicraft items made from the sport-hunted animal only when:
i.
Such items are contained in the same shipment as raw or tanned parts of the sport-hunted animal and
are for the personal use of the hunter;
ii.
The quantity of such items is no more than could reasonably be expected given the number of animals
taken by the hunter as shown on the license or other documentation of the authorized hunt
accompanying the shipment; and
iii.
The accompanying CITES documents (export document and, if appropriate, import permit) contain a
complete itemization and description of all items included in the shipment.
Note 6: Certain hunting trophies, including elephants, are subject to restrictions on their use after import into the United
States. Please see 50 CFR 23.55 for more information or contact the Division of Management Authority.
•
•
•
•

Complete all questions on the application.
Mark questions that are not applicable with "N/A".
If applying for more than one trophy species, be sure to answer questions 5, 6, and 7 for each trophy.
If importing trophies from more than one country, you must submit a separate application for each
shipment in order to obtain separate import permits.

1. Name and address where you wish the permit to be mailed, if different from page 1. If you would like expedited
shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If
unspecified, all documents will be mailed via the U.S. Postal Service.

2. Who should we contact if we have questions about the application (name, phone number, and e-mail)?

3. Have you or your client (if a broker applying on behalf of your client), been assessed a civil penalty or convicted of
any criminal provision of any statute or regulation relating to the activity for which the application is filed; been
convicted, or entered a plea of guilty or nolo contendere, for a felony violation of the Lacey Act, the Migratory Bird
Treaty Act, or the Bald and Golden Eagle Protection Act; forfeited collateral; OR are currently under charges for
any violation of the laws mentioned above?

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FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

☐ No ☐ Yes
If you answered “Yes” to Question 3, provide: a) the individual’s name; b) date of charge; c) charge(s); d) location
of incident; e) court, and f) action taken for each violation. Please be aware that a “Yes” response does not
automatically disqualify you from getting a permit.

4. How many Bontebok (Damaliscus pygargus pygargus) are you applying to import? Quantity:______
a. At the time of the application, the specimen(s) is/are:
☐ Alive

☐ Dead

b. If specimen(s) is/are still alive, what is the approximate date of proposed take? __________________
c.

If dead, what is the date you took the animal(s)? ___________________________

d. What is the approximate age and sex (if known) of the animal(s)? __________________________
e. The current location of the trophy/trophies (address and country) [the U.S. import permit will identify this
country as the country of export/re-export and must match with the CITES export/re-export document]:

5. ENTER the name and address of the landowner on whose property the bontebok was or will be taken:
Owners name:
Farm Name:
District:
Address:
City:
State/Province:
Country, Postal Code:
Please be aware that the bontebok is listed in Appendix II of CITES. As such, you must obtain a
CITES export permit from South Africa. If you are not exporting the trophy from South Africa directly
to the United States, you will need to obtain a CITES re-export certificate from the re-exporting
country.
6. Attach a signed statement from the landowner giving you permission to cull a bontebok from their captive
herd.

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FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

7. If available, provide a copy of the landowner’s Certification of Registration for the bontebok herd. (Note: this
is not a copy of the CITES export permit but a certificate issued by the South African province.) In order to
meet the criteria for a permit under the Endangered Species Act, the bontebok must be culled from a ranch
that has been certified by the Government of South Africa under their bontebok program. If the ranch is not
registered, we may be unable to issue an import permit.
8. Complete name and address of overseas person or business shipping the trophy to you (this name will
appear on the face of the permit).
Name:
Business Name:
Address:
Address:
City:
State/Province:
Country, Postal Code:
CERTIFICATION STATEMENT (original signature must be provided for either 9 or 10 below)
9. If you are a broker or taxidermist applying on behalf of a U.S. hunter or foreign national, provide
documentation to show you have a Power of Attorney to act on your client’s behalf and sign the following
statement.

I acknowledge that the sport-hunted trophy/trophies to be imported has been/will be personally hunted by
my client and is being imported only for my client's personal use (i.e., not for sale, transfer, donation, or
exchange that is reasonably likely to result in economic use, gain, or benefit).

Taxidermist/Broker’s signature: ____________________________________ Date: ______________

10. If you are the hunter applying to import your own trophy, please read and sign the following statement.

I acknowledge that the sport-hunted trophy/trophies to be imported has been/will be personally hunted by
me and is being imported only for my personal use (i.e., not for sale, transfer, donation, or exchange
that is reasonably likely to result in economic use, gain, or benefit).

Applicant's signature: ____________________________________________ Date: ___________

Be aware that there may be additional permitting or approval requirements by your local or state governments,
as well as required by other Federal agencies or foreign government to conduct your propose activity. While the
Service will attempt to assist where possible, it is your responsibility to obtain such approval.

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FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

All international shipment(s) must be through a designated port. A list of designated ports (where an inspector is
posted) is available from the list of designated ports. If you wish to use a port not listed, please contact the
Office of Law Enforcement for a Designated Port Exemption Permit (form 3-200-2).

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FWS Form 3-200-22 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16
U.S.C. 668), 50 CFR 22; the Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act
(16 U.S.C. 703-712), 50 CFR 21; the Marine Mammal Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; the Wild Bird
Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), 50 CFR 23; General
Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions (Import/export/transport), 50 CFR
14.
Purpose: The collection of contact information is to verify the individual has an eligible permit to conduct activities which
affect protected species. This helps FWS monitor and report on protected species and assess the impact of permitted
activities on the conservation and management of species and their habitats.
Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities
with protected wildlife; to provide the public and the permittees with permit related information; to monitor activities under
a permit; to analyze data and produce reports to monitor the use of protected wildlife; to assess the impact of permitted
activities on the conservation and management of protected species and their habitats; and to evaluate the effectiveness
of the permit programs. More information about routine uses can be found in the System of Records Notice, Permits
System, FWS-21.
Disclosure: The information requested in this form is voluntary. However, submission of requested information is
required to process applications for permits authorized under the listed authorities. Failure to provide the requested
information may be sufficient cause for the U.S. Fish & Wildlife Service to deny the request.
PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) in order provide the U.S. Fish
and Wildlife Service the information necessary, under the applicable laws governing the requested activity, for which a
permit is requested. Information requested in this form is purely voluntary. However, submission of requested information
is required in order to process applications for permits authorized under the applicable laws. Failure to provide all
requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. According to the
Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of
information and assigned Control No. 1018-0093.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages 15 minutes (electronically) to 20 minutes
(paper-based), including time for reviewing instructions, gathering and maintaining data and completing and reviewing the
form. Direct comments regarding the burden estimate or any other aspect of the form to the Service Information
Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB/PERMA
(JAO), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this
address.

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