Form CBP Form 5125 CBP Form 5125 Application for Withdrawal of Bonded Stores for Fishing

DEPARTMENT OF HOMELAND SECURITY

OMB CONTROL NUMBER: 1651-0092
EXPIRATION DATE: 11/30/2025

U.S. Customs and Border Protection

APPLICATION FOR WITHDRAWAL OF BONDED STORES
FOR FISHING VESSEL AND CERTIFICATE OF USE

19 U.S.C. 1309, 1317; 19 CFR 10.59, 10.65; 27 CFR 290; CD 099-3260-050
NAME OF VESSEL

VESSEL I.D. NUMBER

DOCUMENT NO.

HOME PORT

PLACE OF DEPARTURE

DESTINATION

DATE OF DEPARTURE

LENGTH OF VOYAGE (DAYS)

CREW MEMBER NAMES (Last, First, M.I.)

NO. OF CREW ON VESSEL

ADDRESSES (Street, City, State, Zip)

PORT OF RETURN

SOCIAL SECURITY NUMBERS

THIS APPLICATION IS HEREBY MADE for the conditionally free withdrawal, under Section 309 of the Tariff Act of 1930, as amended, of the
following articles to be used exclusively as supplies on the vessel during the voyage:
LIST OF ARTICLES

In making this application, I am aware of the provisions of law relating to a false declaration and I stipulate and agree to be bound by the
conditions specified below upon arrival.
DATE

SIGNATURE OF WITHDRAWER

APPLICATION APPROVED SUBJECT TO THE FOLLOWING CONDITIONS:
(1) That this application shall be presented by the withdrawer or the vessel's master to the port director within 24 hours (excluding
Saturday, Sunday, and holidays) after EACH SUBSEQUENT ARRIVAL of the vessel at a Bureau of Customs and Border Protection port
from a fishing voyage, and that an accounting shall be made at the time of such presentation of the disposition of the articles withdrawn
until the port director is satisfied that all vessel supplies have been consumed on board or landed under CBP supervision, there upon the
port director will collect this form for final disposition;
(2) that any such withdrawn article remaining on board while the vessel is in port shall be safeguarded in the manner and to such extent
as the port director for the port or place of arrival shall deem necessary; and
(3) that failure to comply with the above conditions shall subject the master and/or owner to penalties and/or seizure of the vessel.
PORT

CBP Form 5125 (12/23)

DATE

ENTRY/WITHDRAWAL NO.

SIGNATURE OF CBP OFFICER

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MASTER'S REPORT OF ARRIVAL AND CERTIFICATION
ARRIVED AT (PORT)

DATE AND TIME OF ARRIVAL

I CERTIFY THAT (CHECK APPROPRIATE BOX)

:

NO. OF UNUSED QUANTITIES (IF ANY)

UNUSED QUANTITIES REMAIN ON BOARD AND ARE ADEQUATELY SECURED
ALL CONSUMED AS SUPPLIES ON VESSEL PRIOR TO ITS ARRIVAL
SIGNATURE OF MASTER
DATE AND TIME REPORT RECEIVED

PORT

SIGNATURE OF CBP OFFICER

:
ARRIVED AT (PORT)

DATE AND TIME OF ARRIVAL

:

NO. OF UNUSED QUANTITIES (IF ANY)

I CERTIFY THAT (CHECK APPROPRIATE BOX)
UNUSED QUANTITIES REMAIN ON BOARD AND ARE ADEQUATELY SECURED
ALL CONSUMED AS SUPPLIES ON VESSEL PRIOR TO ITS ARRIVAL
SIGNATURE OF MASTER

DATE AND TIME REPORT RECEIVED

PORT

SIGNATURE OF CBP OFFICER

:
ARRIVED AT (PORT)

DATE AND TIME OF ARRIVAL

I CERTIFY THAT (CHECK APPROPRIATE BOX)

:

NO. OF UNUSED QUANTITIES (IF ANY)

UNUSED QUANTITIES REMAIN ON BOARD AND ARE ADEQUATELY SECURED
ALL CONSUMED AS SUPPLIES ON VESSEL PRIOR TO ITS ARRIVAL
SIGNATURE OF MASTER
DATE AND TIME REPORT RECEIVED

PORT

SIGNATURE OF CBP OFFICER

:
ARRIVED AT (PORT)

DATE AND TIME OF ARRIVAL

I CERTIFY THAT (CHECK APPROPRIATE BOX)

:

NO. OF UNUSED QUANTITIES (IF ANY)

UNUSED QUANTITIES REMAIN ON BOARD AND ARE ADEQUATELY SECURED
ALL CONSUMED AS SUPPLIES ON VESSEL PRIOR TO ITS ARRIVAL
SIGNATURE OF MASTER

PORT

DATE AND TIME REPORT RECEIVED

SIGNATURE OF CBP OFFICER

:

FURTHER REPORTS TO BE ENDORSED ON REVERSE, AS NEEDED.

Paperwork Reduction Act Notice

CBP Form 5125 (12/23)

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