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REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
xx-xxxx
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 1 of 7
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
APPROVED COPY
Page 2 of 7
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 3 of 7
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 4 of 7
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
OFM COPY
Page 5 of 7
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
See Page 7
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
CUSTOMER COPY
Page 6 of 7
OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 15 Minutes
Convention
on7 Consular Relations
See Page
U.S. Department of State
PRIVACY ACT STATEMENT
AUTHORITIES: The information is REQUEST
sought pursuant
to Vienna
Convention
on Diplomatic Relations
of 1961; Vienna
FOR
CUSTOMS
CLEARANCE
OF MERCHANDISE
of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions Act of 1982
(22 the
U.S.C.
4301-4316)
amended.
To
Secretary
ofasState
- Attention: Office of Foreign Missions
ItPURPOSE:
is requestedThe
thatinformation
the necessary
arrangements
be will
made
thetoappropriate
authorities
admit free
of duty the
merchandise described below. This
solicited
on this form
be for
used
adjudicate requests
fortocustoms
clearance
of merchandise.
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
PortThis
of Clearance
statutorily
authorized
purposes
covered under
STATE 36,
Security
Records.
information also may be provided to the employing foreign
Name
of Embassy,
Legation,
or as
International
Organization
(Includes
U.N.)
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of customs
Consignee
clearance of merchandise.
Name (First, Middle, Last)
Title
PAPERWORK
REDUCTION ACT STATEMENT
Purpose
*Public reporting burden for this collection of information is estimated to average
minutes per response, including time required for searching
Enter15
PID
or
existing data sources, gathering the necessary documentation, providing the information
and/or documents required, and reviewing the final collection.
Official (Explain Below)
Personal
Official and Personal If Newly Assigned Check Here
You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the
Carrier/Supplier
Customs Entry or Manifest Number Air Waybill or Bill of Lading Number
accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW, Washington,
DC 20008.
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
Page 7 of 7
| File Type | application/pdf |
| File Title | DS-1504 |
| Author | ciupekra |
| File Modified | 2014-11-18 |
| File Created | 2014-11-18 |