1. TO: CBP Port Director (Address) TO CBP PORT DIRECTOR 2. FROM: (Name and Address of Importer or Agent) ATTACH COPY OF EXPORT INVOICE DESCRIBING ARTICLES TO BE EXPORTED 4. Date of Departure 5. Country of Origin 6. No. of Export Packages 7. Port of Entry 10. Date Articles Available for CBP Examination 8. Entry Number Date 9. Date Bonded Period Expires 11. Signature of Importer or Agent 12. Date (FOR CBP USE ONLY) NOTICE TO IMPORTER TO DELIVER ARTICLES TO BE EXAMINED AND IDENTIFIED FOR EXPORTATION 13. Place of CBP Examination Date 14. Date 15. CBP PORT DIRECTOR BY: REPORT OF EXAMINATION 16. The articles covered by this application have been examined and agree with the invoice in content and No. of export pkgs. and are approved for export. 17. No. of Export Packages 18. Date of Delivery for Exportation 19. Marks and Numbers on Export Packages 20. The articles covered by this application do not agree with the invoice in content or in number of packages as follows 21. SIGNATURE OF EXAMINING CBP OFFICER 22. DATE REPORT OF EXPORTATION 23. Home of Exporting Conveyance (Vessel, Railroad, Airline and Flight Number) 24. Date of Departure 26. SIGNATURE OF CBP OFFICER (CBP officer must return one copy of this form to port of origin upon exportation.) (Previous Editions are Obsolete) 25. Manifest No. 3. Name of Exporting Carrier Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0004. Obligation to respond is required to Obtain Benefits. The estimated average time to complete this application is 8 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Trade, Regulations and Rulings, 90 K Street, NE., Washington DC 20229. DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection APPLICATION FOR EXPORTATION OF ARTICLES UNDER SPECIAL BOND 19 CFR 10.38 OMB APPROVAL NO. 1651-0004 EXPIRATION DATE 08-31-2017 ESTIMATED BURDEN 8 MIN. CBP Form 3495 (8/17) Page 1 of 1

APPLICATION FOR EXPORTATION OF ARTICLES UNDER …...1. TO: CBP Port Director (Address). TO CBP PORT DIRECTOR. 2. FROM: (Name and Address of Importer or Agent) ATTACH COPY OF EXPORT

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1. TO: CBP Port Director (Address)

TO CBP PORT DIRECTOR2. FROM: (Name and Address of Importer or Agent)

ATTACH COPY OF EXPORT INVOICE DESCRIBING ARTICLES TO BE EXPORTED4. Date of Departure 5. Country of Origin 6. No. of Export Packages

7. Port of Entry

10. Date Articles Available for CBP Examination

8. Entry Number Date 9. Date Bonded Period Expires

11. Signature of Importer or Agent 12. Date

(FOR CBP USE ONLY) NOTICE TO IMPORTER TO DELIVER ARTICLES TO BE EXAMINED AND IDENTIFIED FOR EXPORTATION

13. Place of CBP Examination Date

14. Date 15. CBP PORT DIRECTORBY:

REPORT OF EXAMINATION

16. The articles covered by this application have been examined and agree with the invoice in content and No. of export pkgs. and are approved for export.

17. No. of Export Packages 18. Date of Delivery for Exportation 19. Marks and Numbers on Export Packages

20. The articles covered by this application do not agree with the invoice in content or in number of packages as follows

21. SIGNATURE OF EXAMINING CBP OFFICER 22. DATE

REPORT OF EXPORTATION23. Home of Exporting Conveyance (Vessel, Railroad, Airline and Flight Number)

24. Date of Departure

26. SIGNATURE OF CBP OFFICER

(CBP officer must return one copy of this form to port of origin upon exportation.)(Previous Editions are Obsolete)

25. Manifest No.

3. Name of Exporting Carrier

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0004. Obligation to respond is required to Obtain Benefits. The estimated average time to complete this application is 8 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Trade, Regulations and Rulings, 90 K Street, NE., Washington DC 20229.

DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection

APPLICATION FOR EXPORTATION OF ARTICLES UNDER SPECIAL BOND 19 CFR 10.38

OMB APPROVAL NO. 1651-0004 EXPIRATION DATE 08-31-2017 ESTIMATED BURDEN 8 MIN.

CBP Form 3495 (8/17) Page 1 of 1