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Sample ATA Carnet ATA Carnet By Roanoke A service provider for the U.S. Council for International Business (USCIB)

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Page 1: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

Sample ATA Carnet

ATA Carnet By RoanokeA service provider for the U.S. Council for International Business (USCIB)

Page 2: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

Instructions for Using Your ATA CarnetFailure to follow these instructions may delay your departure from the U.S.,entry into the importing country, and may result in the payment of duties, taxes, and/or penalties.

Definitions

Holder: An entity on whose behalf the Carnet has been issued. A Holder must have a benefi cial economic interest in the mer chandise being exported and is responsible for any duties, taxes and/or penal-ties that become payable.

Authorized Representative: An entity authorized by the Holder to present the Carnet for customs clearance in the U.S. and/or abroad.

Green Cover: The principal page of a Carnet, which includes the Holder and Carnet information, Carnet countries, customs certifi cate to initiate the Carnet, and the original General List.

Counterfoils and vouchers (color-coded): Yellow for exit from/return to the U.S., white for entry into/departure from for eign coun-tries, and blue for transit. Counterfoils and vouchers are issued in sets of two. There are no yellow vouchers for U.S. Carnets. The validation of a counterfoil and its corre sponding voucher constitutes a single customs transaction.

Counterfoil: The Holder’s record of a customs transaction. There are three different sets of counterfoils: 1) exportation & reimpor tation, 2) importation & reexportation, and 3) transits.

Voucher: The control document for Foreign Customs use. Customs will remove and retain the voucher upon completion of a customs transaction. There are two different sets of vouchers: 1) impor tation & reexportation, and 2) transits.

Checklist Upon Receiving Your Carnet

Verify that all information on the Green Cover, vouchers, and General List is correct. Never amend, remove or substitute the original General List.

Sign the Green Cover in the space marked “Signature of Holder.” The signature must be of the Holder or an authorized representative.Confi rm that the correct number of counterfoils and vouchers has been issued to cover all intended customs transactions. Additional sets may be purchased later.

Split or partial shipments: It is permissible to split a shipment (i.e., some items leave now and the remainder at a later date) or to take fewer items abroad than shown on the General List. In either instance, cross out the items not traveling on the Carnet from the General List on the backs of the vouchers to be present ed to customs.

All procedures apply equally to items shipped as cargo or carry- on baggage.

Arrive early! It is the Carnet Holder’s responsibility to locate a cus-toms inspector to validate the Carnet. If traveling during non-business hours, call the local customs offi ce to ensure that an inspector famil-iar with Carnets will be available.

Instructions continued

Upon completion of the last trip or Carnet expiration, return the Carnet by receipted mail to:

Roanoke TradeAttn: ATA Carnet Department1475 E. Woodfield Road, Suite 500Schaumburg, IL 60173Tel: 1.800.CARNETS ( 1.800.227.6387)

ATA Carnet

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*If applicable / *S'il y a lieu

A.T.A. CARNET CARNET A.T.A.

FOR TEMPORARY ADMISSION OF GOODSPOUR L'ADMISSION TEMPORAIRE DE MARCHANDISES

CUSTOMS CONVENTION ON THE A.T.A. CARNET FOR THE TEMPORARY ADMISSION OF GOODSCONVENTION DOUANIERE SUR LE CARNET A.T.A. POUR L'ADMISSION TEMPORAIRE DE MARCHANDISES

CONVENTION ON TEMPORARY ADMISSION / CONVENTION RELATIVE À L'ADMISSION TEMPORAIRE

(Before completing the Carnet, please read Notes on cover page 3 / Avant de remplir le carnet, lire la notice en page 3 de la couverture)

ATA

CARNET

CARNET

ATA

A. HOLDER AND ADDRESS / Titulaire et adresse G. FOR ISSUING ASSOCIATION USE / Réservé à l'association é mettriceFRONT COVER / Couverture

b) ISSUED BY / Délivré par

a) A.T.A. CARNET No.Carnet A.T.A. N o

Number of continuation sheets:Nombre de feuilles supplé mentaires: ......................................................

c) VALID UNTIL / Valable jusqu'au

.........................................................................................................................year month day (inclusive)

)sulcni( ruojsiomeénna

I. Signature of authorized official and IssuingAssociation stamp / Signature du délégué ettimbre de l'association émettrice

.......................................................................................

Place and Date of Issue (year/month/day)Lieu et date d'émission (année/mois/jour)

J.

X...............................................................................XSignature of Holder / Signature du titulaire

B. REPRESENTED BY* / Repré.senté par*

C. INTENDED USE OF GOODS / Utilisation prévue des marchandises

H. CERTIFICATE BY CUSTOMS AT DEPARTUREAttestation de la douane, au départ

a) Identification marks have been affixed as indicated in column 7against the following items No(s). of the General ListApposé les marques d'identification mentionnées dans la colonne 7 enregard du (des) numéro(s) d'ordre suivant(s) de la liste générale

..............................................................................................................................

..............................................................................................................................

b) GOODS EXAMINED* / Vérifié les marchandises*Yes / Oui No / Non

c) Registered under Reference No.*Enregistré sous le numéro* ................................

d) ............................................................ / .......... / ...............................................Customs Office Place Date (year/month/day) Signature and StampBureau de douane Lieu Date (année/mois/jour) Signature et timbre

P. This Carnet may be used in the following countries/customs territories under the guarantee of the associations listed on page 4 of the cover:/Ce carnet est valable dans les pays/ territoires douaniers ci-après, sous la garantie des associations reprises en page quatre de la couverture:

THE CARNET IS THE PROPERTY OF USCIB. AFTER FINAL USE, RETURN IT TO ROANOKE TRADE.

1475 E. WOODFIELD ROAD, SUITE 500, SCHAUMBURG, IL 60173, ATTN:ATA CARNET DEPARTMENT(A RETOURNER A LA CHAMBRE EMETTRICE IMMEDIATEMENT APRES UTILISATION)

United States Council for International Business

The Holder of this Carnet and his representative will be held responsible for compliance with the laws and regulations of the country/customs territory of departure and the countries/customs territories of importation./A charge pour le tituaire et son représentant de se conformer aux lois et règlements du pays/territoire douanier de départ et des pays/territoires douaniers d'importation.

EUROPEAN UNION

OTHER COUNTRIES

N1 (01/21/16)

Issuing AssociationAssociation émettrice

ALBANIA (AL)ALGERIA (DZ)ANDORRA (AD)AUSTRALIA (AU)BAHRAIN (BH)BELARUS (BY)BOSNIA and HERZEGOVINA (BA)CANADA (CA)CHILE (CL)CHINA (CN)GIBRALTAR (GI)HONG KONG, CHINA (HK)

ICELAND (IS)INDIA (IN)INDONESIA (ID)ISRAEL (IL)IVORY COAST (CI)JAPAN (JP)KOREA (KR)LEBANON (LB)MACAO, CHINA (MO)MACEDONIA (MK)MADAGASCAR (MG)MALAYSIA (MY)

MAURITIUS (MU)MEXICO (MX)MOLDOVA (MD)MONGOLIA (MN)MONTENEGRO (ME)MOROCCO (MA)NEW ZEALAND (NZ)NORWAY (NO)PAKISTAN (PK)RUSSIA (RU)SENEGAL (SN)

SERBIA (RS)SINGAPORE (SG)SOUTH AFRICA (ZA)SRI LANKA (LK)SWITZERLAND (CH)THAILAND (TH)TUNISIA (TN)TURKEY (TR)UKRAINE (UA)UNITED ARAB EMIRATES (AE)UNITED STATES (US)

AUSTRIA (AT)BELGIUM (BE)BULGARIA (BG)CROATIA (HR)CYPRUS (CY)CZECH REPUBLIC (CZ)DENMARK (DK)

ESTONIA (EE)FINLAND (FI)FRANCE (FR)GERMANY (DE)GREECE (GR)HUNGARY (HU)IRELAND (IE)

ITALY (IT)LATVIA (LV)LITHUANIA (LT)LUXEMBOURG (LU)MALTA (MT)NETHERLANDS (NL)POLAND (PL)

PORTUGAL (PT)ROMANIA (RO)SLOVAKIA (SK)SLOVENIA (SI)SPAIN (ES)SWEDEN (SE)UNITED KINGDOM (GB)

International Guarantee ChainChaîne de garantie internationale

2015 04 30

USA Exporters Incorporated61 BroadwaySuite 2700 US3/1412101New York,NY 10006

0

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRSCOMMERCIAL SAMPLESPROFESSIONAL EQUIPMENT

1

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General ListReverse of Green Cover

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The ORIGINAL General List will be printed on the reverse side of the Green Cover. If the General List is more than one page, Con-tinuation Sheets will follow this page. The ORIGINAL General List will always remain with the ATA Carnet.

Continuation Sheets are numbered beginning with the first attached page.

The General List descrip-tion should be as complete as possible and must show model numbers, serial num-bers, and unique identifying marks where applicable.

The General List is “goods specific,” therefore no sub-stitutions may be made.

Like items may be listed on the same line.

The weight and value for each line is the total weight or value for all items on that line.

The country of origin is the country in which the goods were manufactured.

IMPORTANT: NO changes or amendments may be made to the ORIGINAL General List, once released from your issuing office.

Never Ever Amend the

Green General List

2

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Exportation / Re-importation Counterfoils

*If applicable / *S'il y a lieu/

CounterfoilSouche

No.No

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been exported.ont été exportées

3. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..........................................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for duty-free re-importationDate limite pour la réimportation en franchise year / month / day

année / mois / jour/ /

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s)............................................................................................................................. ........................................

......................................................................................................................................................................................................................................................................................

which were temporarily exported under cover of exportation voucher(s) No(s). of this Carnet have been re-imported*.exportées temporairement sous couvert du (des) volet(s) d'exportation No(s) ..............................................................du présent carnet ont été réimportées*

2. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..........................................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

FO

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BY

U.S

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1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s)............................................................................................................................. ........................................

......................................................................................................................................................................................................... have been exported.ont été exportées

3. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..........................................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for duty-free re-importationDate limite pour la réimportation en franchise year / month / day

année / mois / jour/ /

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................................................................................................

which were temporarily exported under cover of exportation voucher(s) No(s). of this Carnet have been re-imported*.exportées temporairement sous couvert du (des) volet(s) d'exportation No(s) ............................................................. du présent carnet ont été réimportées*

2. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..........................................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

N2 (04/04)

COUNTERFOIL

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

REI

MPORTATION

REI

MPORTATION

REI

MPORTATION

REI

MPORTATION

EXPORTATION

EXPORTATION

EXPORTATION

EXPORTATION

US3/1412101

1

1

2

2

The Yellow Counterfoils along with the Green Cover and Green General List can be used in place of the CBP form 4455 which is the Cer-tificate of Registration for commercial goods leaving and returning to the United States.

The yellow pages are for use in the United States and contain pairs of Exporta-tion and Re-importation counterfoils.

Each time you depart the United States, an Exporta-tion counterfoil must be completed by a U.S. Cus-toms official.

When you re-enter the U.S. a Re-importation counterfoil must be completed by a U.S. Customs official.

Although the counterfoils are generally completed in their entirety by a U.S CBP official, it is acceptable for the Holder or Authorized Representative to complete box 1 on the counterfoils by entering the line item num-bers of the goods that will be exported or re-imported. As well as noting in box 3 the Airway Bill or Bill of Lading or Flight number corresponding to this ship-ment or hand carry.

NOTE: There are NO corre-sponding yellow vouchers for U.S. CBP.

IMPORTANT: Obtaining a U.S. CBP validation upon re-entry into the U.S. is your last line of defense against a claim from foreign cus-toms.

There will be enough Expor-tation and Re-importation counterfoils available in your ATA Carnet to corre-spond with the number of trips you indicated you would be taking at the time of your application.

Any sets of counterfoils beyond the number original-ly requested will be marked as “VOID” across the face of the counterfoil and may not be used. If additional sets of Exportation/Re-im-portation counterfoils are required for continued travel, contact your ATA Carnet Service Representa-tive at 1.800.CARNETS (1.800.227.6387).

*conditional

Example of Full Export and Re-Import 1-15

2015 04 30

2015 04 30

1, 3, 5-10, 12, 15

1, 3, 5-10, 12, 15

US CBP (Customs) stamps here

US CBP (Customs) stamps here

US CBP (Customs) stamps here

US CBP (Customs) stamps here

Airway Bill/Bill of Lading/-Flight No.

*License Number

Example of a Partial Shipment on ATA Carnet

Example of a Partial Shipment on ATA Carnet

Airway Bill/Bill of Lading/-Flight No.

*License Number and ITN*No EEI per 30.37(q)

3

1-15

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Exportation / Re-importation CounterfoilReverse

*If applicable / *S'il y a lieu/

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been exported.ont été exportées

3. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..........................................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for duty-free re-importationDate limite pour la réimportation en franchise year / month / day

année / mois / jour/ /

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................................................................................................

which were temporarily exported under cover of exportation voucher(s) No(s). of this Carnet have been re-imported*.exportées temporairement sous couvert du (des) volet(s) d'exportation No(s) ............................................................ du présent carnet ont été réimportées*

2. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..........................................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been exported.ont été exportées

3. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..........................................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for duty-free re-importationDate limite pour la réimportation en franchise year / month / day

année / mois / jour/ /

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................................................................................................

which were temporarily exported under cover of exportation voucher(s) No(s). of this Carnet have been re-imported*.exportées temporairement sous couvert du (des) volet(s) d'exportation No(s) ............................................................. du présent carnet ont été réimportées*

2. Other remarks* / Autres mentions*

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..........................................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

COUNTERFOIL

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

REI

MPORTATION

REI

MPORTATION

EXPORTATION

EXPORTATION

REI

MPORTATION

REI

MPORTATION

EXPORTATION

EXPORTATION

FO

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BY

U.S

. CU

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US3/1412101

VOID

VOID

VOID

VOID

The reverse side of the yellow Exportation and Re-importation Counterfoils will contain additional sets of counterfoils.

If your ATA Carnet applica-tion noted that you would be making more than two trips out of/into the U.S., these counterfoils will be num-bered and may be validated by U.S. Customs and Border Protection.

If you did not request these sets of counterfoils with your original application, they will be marked as “VOID” across the face of the counterfoil and may not be used.

If additional sets of Expor-tation/Re-importation coun-terfoils are required for con-tinued travel, contact your ATA Carnet Service Repre-sentative at 1.800.CARNETS (1.800.227.6387).

4

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Importation / Re-exportation Counterfoils

/ *S'il y a lieu

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been temporarily imported.ont été importées temporairement

3. Registered under reference No.* / Enregistré sous le N o*

................................................................................................................................................................................................

4. Other remarks* / Autres mentions*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for re-exportation / production to the Customs of goods*/Date limite pour la réexportation / la représentation à la douane, des marchandises* year / month / day

année / mois / jour/ /

*If applicable

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................which were temporarily imported under cover of importation voucher(s) No(s).importées temporairement sous couvert du (des) volet(s) d'importation No(s) ................................................................... of this Carnet have been re-exported*.

du présent carnet, ont été réexportées*

3. Action taken in respect of goods not produced and not intended for later re-exportation*/Mesures prises à l'égard des marchandises non représentées et non destinées à une réexporation ultérieure*

................................................................................................................................................................................................

4. Registered under reference No.*/ Enregistré sous le No*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Action taken in respect of goods produced but not re-exported*/Mesures prises à l'é gard des marchandises représentées mais non réexportées* ........................................................................................................................................

......................................................................................................................................................................................................................................................................................

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................which were temporarily imported under cover of importation voucher(s) No(s).importées temporairement sous couvert du (des) volet(s) d'importation No(s) ................................................................... of this Carnet have been re-exported*.

du présent carnet, ont été réexportées*

3. Action taken in respect of goods not produced and not intended for later re-exportation*/Mesures prises à l'égard des marchandises non représentées et non destinées à une reexporation ultérieure*

................................................................................................................................................................................................

4. Registered under reference No.*/ Enregistré sous le No*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Action taken in respect of goods produced but not re-exported*/Mesures prises à l'é gard des marchandises représentées mais non réexportées* ........................................................................................................................................

......................................................................................................................................................................................................................................................................................

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been temporarily imported.ont été importées temporairement

3. Registered under reference No.* / Enregistré sous le N o*

................................................................................................................................................................................................

4. Other remarks* / Autres mentions*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for re-exportation / production to the Customs of goods*/Date limite pour la réexportation / la représentation à la douane, des marchandises* year / month / day

année / mois / jour/ /

COUNTERFOIL

N5 (04/04)

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

IMPORTATION

IMPORTATION

REEXPORTATION

REEXPORTATION

REEXPORTATION

REEXPORTATION

IMPORTATION

IMPORTATION

FO

R U

SE

BY

CU

ST

OM

S O

F C

OU

NT

RY

/CU

ST

OM

S T

ER

RIT

OR

Y O

F T

EM

PO

RA

RY

IMP

OR

TAT

ION

/R

ÉS

ER

À L

A D

OU

AN

E D

U P

AY

S/T

ER

RIT

OIR

E D

OU

AN

IER

D'IM

PO

RTA

TIO

N T

EM

PO

RA

IRE

US3/1412101

1

1

2

2

The white pages are for use in foreign countries and contain pairs of Importa-tion and Re-exportation counterfoils.

White Importation and Re-exportation Counterfoils also have corresponding vouchers (see following pages).

The counterfoils will be retained in the ATA Carnet as your proof of importation and re-exportation of your goods.

Each time you enter a foreign country, the ATA Carnet must be presented to foreign customs and an Importation Counterfoil AND its corresponding voucher must be completed.

IMPORTANT: Goods must be exported by midnight of the “Final date for re-expor-tation” (section 2 of the Importation Counterfoil).

When you depart the foreign country, the ATA Carnet must be presented to customs and a Re-expor-tation Counterfoil AND its corresponding voucher completed.

Any sets of counterfoils beyond the number original-ly requested will be marked as “VOID” across the face of the counterfoil and may not be used.

Additional sets of Importa-tion/Re-exportation Coun-terfoils may be obtained by contacting your ATA Carnet Service Representative at 1 . 8 0 0 . C A R N E T S (1.800.227.6387).

IMPORTANT: Failure to have the Re-exportation Voucher validated when departing a foreign country will result in a foreign cus-toms claim.

Example of Full Import and

Re-Export 1-15

1-151

1, 3, 5-10, 12, 15

1, 3, 5-10, 12, 15

2015 04 30

2015 04 30

2

Foreign Customs Stamps Here

Foreign Customs Stamps Here

Foreign Customs Stamps Here

Example of a Partial Shipment on ATA Carnet

Airway bill/Bill of Lading/-Flight No.

Airway bill/Bill of Lading/-Flight No.

Airway bill/Bill of Lading/-Flight No.

Foreign Customs Stamps Here

Airway bill/Bill of Lading/-Flight No.

5

Goods must departby this date

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Importation / Re-exportation CounterfoilReverse

/ *S'il y a lieu

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been temporarily imported.ont été importées temporairement

3. Registered under reference No.* / Enregistré sous le N o*

................................................................................................................................................................................................

4. Other remarks* / Autres mentions*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for re-exportation / production to the Customs of goods*/Date limite pour la réexportation / la représentation à la douane, des marchandises* year / month / day

année / mois / jour/ /

*If applicable

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) ............................................................................................................................. ........................................which were temporarily imported under cover of importation voucher(s) No(s).importées temporairement sous couvert du (des) volet(s) d'importation No(s) ................................................................... of this Carnet have been re-exported*.

du présent carnet, ont été réexportées*

3. Action taken in respect of goods not produced and not intended for later re-exportation*/Mesures prises à l'égard des marchandises non représentées et non destinées à une réexporation ultérieure*

................................................................................................................................................................................................

4. Registered under reference No.*/ Enregistré sous le No*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Action taken in respect of goods produced but not re-exported*/Mesures prises à l'é gard des marchandises représentées mais non réexportées* ........................................................................................................................................

......................................................................................................................................................................................................................................................................................

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................which were temporarily imported under cover of importation voucher(s) No(s).importées temporairement sous couvert du (des) volet(s) d'importation No(s) ................................................................... of this Carnet have been re-exported*.

du présent carnet, ont été réexportées*

3. Action taken in respect of goods not produced and not intended for later re-exportation*/Mesures prises à l'égard des marchandises non représentées et non destinées à une reexporation ultérieure*

................................................................................................................................................................................................

4. Registered under reference No.*/ Enregistré sous le No*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Action taken in respect of goods produced but not re-exported*/Mesures prises à l'é gard des marchandises représentées mais non réexportées* ........................................................................................................................................

......................................................................................................................................................................................................................................................................................

1. The goods described in the General List under Item No(s).Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................

......................................................................................................................................................................................................... have been temporarily imported.ont été importées temporairement

3. Registered under reference No.* / Enregistré sous le N o*

................................................................................................................................................................................................

4. Other remarks* / Autres mentions*

................................................................................................................................................................................................

5.

........................................................Customs Office

Bureau de douane

6.

..................................................PlaceLieu

8.

..........................................................................Signature and Stamp

Signature et timbre

7.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

2. Final date for re-exportation / production to the Customs of goods*/Date limite pour la réexportation / la représentation à la douane, des marchandises* year / month / day

année / mois / jour/ /

COUNTERFOIL

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

REEXPORTATION

REEXPORTATION

IMPORTATION

IMPORTATION

REEXPORTATION

REEXPORTATION

IMPORTATION

IMPORTATION

FO

R U

SE

BY

CU

ST

OM

S O

F C

OU

NT

RY

/CU

ST

OM

S T

ER

RIT

OR

Y O

F T

EM

PO

RA

RY

IMP

OR

TAT

ION

/R

ÉS

ER

À L

A D

OU

AN

E D

U P

AY

S/T

ER

RIT

OIR

E D

OU

AN

IER

D'IM

PO

RTA

TIO

N T

EM

PO

RA

IRE

US3/1412101

VOID

VOID

VOID

VOID

The reverse side of the white Importation and Re-exportation Counter-foils will also contain sets of counterfoils.

If your ATA Carnet applica-tion noted that you would be making more than two trips to foreign countries, these counterfoils will be numbered and may be vali-dated by foreign customs.

If you did not request these sets of counterfoils with your original application, they will be marked as “VOID” across the face of the counterfoil and may not be used.

If additional sets of coun-terfoils are required for con-tinued travel, contact your ATA Carnet Service Repre-sentative at 1.800.CARNETS (1.800.227.6387).

6

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C. INTENDED USE OF GOODS/Utilisation prévue des marchandises

A. HOLDER AND ADDRESS/Titulaire et adresse

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

IMPORTATION

IMPORTATION

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. IMPORTATION VOUCHER No.Volet d'importation No

a) A.T.A. Carnet No.Carnet A.T.A. No

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

F. TEMPORARY IMPORTATION DECLARATIONDéclaration d'importation temporaire

I, duly authorized:/Je soussigné, dûment autorisé:

a) declare that I am temporarily importing in compliancewith the conditions laid down in the laws and regulationsof the country/customs territory of importation, the goodsenumerated in the list overleaf and described in theGeneral List under item No(s)./déclare importertemporairement, dans les conditions prévues par les lois etrèglements du pays/territoire douanier d'importation, lesmarchandises énumérées à la liste figurant au verso etreprises à la liste générale sous le(s) No(s)

...........................................................................................................

...........................................................................................................

b) declare that the said goods are intended for use at /déclare que les marchandises sont destinées à être utilisées à

...........................................................................................................

...........................................................................................................

c) undertake to comply with these laws and regulationsand to re-export the said goods within the periodstipulated by the Customs Office or regularize theirstatus in accordance with the laws and regulations ofthe country/customs territory of importation./ m'engageà observer ces lois et règlements et à réexporter cesmarchandises dans les délais fixés par le bureau dedouane ou à régulariser leur situation selon les lois etrèglements du pays/territoire douanier d'importation.

d) confirm that the information given is true and complete./certifie justes et complètes les indications portées sur leprésent volet.

FOR CUSTOMS USE ONLY/Réservé à la Douane

H) CLEARANCE ON IMPORTATION/Dédouanement à l'importation

a) The goods referred to in the above declaration have beentemporarily imported./Les marchandises faisant l'objet de ladéclaration ci-contre ont été importées temporairement

b) Final date for re-exportation/production to Customs*:/Date limite pour la réexportation/la représentation à la douane:*

..........................................................................................................................year month day

année mois jour

c) Registered under reference No.*/Enregistré sous le N o*

..........................................................................................................................

d) Other remarks*:/Autres mentions*:

At/A ........................................................................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

* If applicable/S'il y a lieu

A.T.A. CARNET CARNET A.T.A.

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N6 (06/04)

VOUCHER

USA Exporters Incorporated 161 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

The Importation Voucher is presented to foreign cus-toms along with its corre-sponding counterfoil upon entry into a foreign country. Counterfoils and vouchers are used in sets. For exam-ple: Counterfoil No. 1 with Voucher No. 1.

Vouchers are the control document of customs and are removed, along with the accompanying General List, at the time of each customs clearance.

The Holder or Authorized Representative must com-plete sections “D” through “F.”

Partial and split shipments maybe made. Please see page 11 for details.Airway Bill/Bill of Lading/-

Flight No. Hand Carry

2015 / 04 / 305 cartons total weight 6,000 lbs

1-15

Paris International Expo

MUST match importationcounterfoil

Foreign Customs Stamps Here

Holder/Representative MUST sign here

7

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General ListReverse of Importation Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Importation Vouch-er.

If your General List is more than one page, Continua-tion Sheets will be attached.

If General List pages are not printed and/or Continua-tion Sheets not attached to a voucher, you must photo-copy the complete list and attach it to the voucher PRIOR to presenting to cus-toms. This may be the case with some foreign ATA Car-nets.

Partial and Split shipments maybe made, please see page 12 for details.

8

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C . INTENDED USE OF GOODS/Utilisation prévue des marchandises

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. RE-EXPORTATION VOUCHER No.Volet de réexportation No

a) A.T.A. Carnet No.Carnet A.T.A. No

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

A. HOLDER AND ADDRESS/Titulaire et adresse

FOR CUSTOMS USE ONLY/Réservé à la Douane

H) CLEARANCE ON RE-EXPORTATION/Dédouanement à laréexportation

a) The goods referred to in paragraph F. a) of the Holder'sdeclaration have been re-exported.*/Les marchandisesvisées au paragraph F. a) de la déclaration ci-contre ont étéréexportées*

b) Action taken in respect of goods produced but notre-exported:*/Mesures prises à l'égard des marchandisesreprésentées mais non réexportées:*

..........................................................................................................................c) Action taken in respect of goods NOT produced and NOT

intended for later re-exportation.*/Mesures prises à l'égarddes marchandises non représentées et non destinées à uneréexportation ultérieure.*

..........................................................................................................................d) Registered under reference No.*:/Enregistré sous le No*

..........................................................................................................................e) This voucher must be forwarded to the Customs Office at*:

Le présent volet devra être transmis au bureau de douane de*:

..........................................................................................................................f) Other remarks:*/Autres mentions:*

At/A ........................................................................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

REEXPORTATION

REEXPORTATION

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

F. RE-EXPORTATION DECLARATION/Déclaration de réexportation.

I, duly authorized:/Je soussigné, dûment autorisé:

*a) declare that I am re-exporting the goods enumerated inthe list overleaf and described in the General List underitem No(s)./déclare réexporter les marchandisesénumérées à la liste figurant au verso et reprises à la listegénérale des marchandises sous le(s) No(s)

.................................................................................................................which were temporarily imported under cover ofimportation voucher(s) No(s)./qui ont été importéestemporairement sous le couvert du(des) volet(s)d'importation No(s)

.................................................................................................................of this carnet./du présent carnet

*b) declare that goods produced against the following ItemNo(s). are not intended for re-exportation:/ déclare queles marchandises représentées et reprises sous le(s) No(s)suivant(s) ne sont pas destinées à la réexportation:

.................................................................................................................

*c) declare that goods of the following Item No(s). notproduced, are not intended for later re-exportation:déclare que les marchandises non représentées etreprises sous le(s) No(s) suivant(s) ne seront pasréexportées ultérieurement:

.................................................................................................

*d) in support of this declaration present the followingdocuments/présente à l'appui de mes déclarations, lesdocuments suivants:

.................................................................................................

e) confirm that the information given is true and complete. /certifie justes et complètes les indications portées sur leprésent volet

A.T.A. CARNET CARNET A.T.A.

* If applicable/S'il y a lieu

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N7 (06/04)

VOUCHER

USA Exporters Incorporated 161 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

The Re-exportation Voucher is presented to foreign cus-toms along with its corre-sponding counterfoil upon departure from a foreign country.

The Holder or Authorized Representative must com-plete sections “D” through “F.”

Partial and Split shipments maybe made please see page 11 for details.

Foreign Customs will com-plete and sign the shaded section of the Re-exporta-tion Voucher as well as the corresponding counterfoil and will retain the voucher as proof that the goods have been re-exported from the country.

IMPORTANT: Failure to have the Re-exportation Voucher (and correspond-ing counterfoil) validated by foreign customs will result in a customs claim.

The Holder or Authorized Representative signs the lower right-hand section of the voucher.

Airway Bill/Bill of Lading/-Flight No. Hand Carry

5 cartons total weight 6,000 lbs

1-15

Port of Entry

1

Foreign Customs Stamps Here

Holder/Representative MUST sign here

9

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General ListReverse of Re-exportation Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Re-exportation Voucher.

If your General List is more than one page, Continua-tion Sheets will be attached in most cases.

If General List pages are not printed and/or Continu-ation Sheets not attached to a voucher, you must pho-tocopy the complete list and attach it to the voucher PRIOR to presenting to cus-toms.

Partial and Split shipments maybe made please see page 12 for details.

10

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C. INTENDED USE OF GOODS/Utilisation prévue des marchandises

A. HOLDER AND ADDRESS/Titulaire et adresse

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

IMPORTATION

IMPORTATION

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. IMPORTATION VOUCHER No.Volet d'importation No

a) A.T.A. Carnet No.Carnet A.T.A. No

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

F. TEMPORARY IMPORTATION DECLARATIONDéclaration d'importation temporaire

I, duly authorized:/Je soussigné, dûment autorisé:

a) declare that I am temporarily importing in compliancewith the conditions laid down in the laws and regulationsof the country/customs territory of importation, the goodsenumerated in the list overleaf and described in theGeneral List under item No(s)./déclare importertemporairement, dans les conditions prévues par les lois etrèglements du pays/territoire douanier d'importation, lesmarchandises énumérées à la liste figurant au verso etreprises à la liste générale sous le(s) No(s)

...........................................................................................................

...........................................................................................................

b) declare that the said goods are intended for use at /déclare que les marchandises sont destinées à être utilisées à

...........................................................................................................

...........................................................................................................

c) undertake to comply with these laws and regulationsand to re-export the said goods within the periodstipulated by the Customs Office or regularize theirstatus in accordance with the laws and regulations ofthe country/customs territory of importation./ m'engageà observer ces lois et règlements et à réexporter cesmarchandises dans les délais fixés par le bureau dedouane ou à régulariser leur situation selon les lois etrèglements du pays/territoire douanier d'importation.

d) confirm that the information given is true and complete./certifie justes et complètes les indications portées sur leprésent volet.

FOR CUSTOMS USE ONLY/Réservé à la Douane

H) CLEARANCE ON IMPORTATION/Dédouanement à l'importation

a) The goods referred to in the above declaration have beentemporarily imported./Les marchandises faisant l'objet de ladéclaration ci-contre ont été importées temporairement

b) Final date for re-exportation/production to Customs*:/Date limite pour la réexportation/la représentation à la douane:*

..........................................................................................................................year month day

année mois jour

c) Registered under reference No.*/Enregistré sous le N o*

..........................................................................................................................

d) Other remarks*:/Autres mentions*:

At/A ........................................................................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

* If applicable/S'il y a lieu

A.T.A. CARNET CARNET A.T.A.

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N6 (06/04)

VOUCHER

USA Exporters Incorporated 261 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

The Importation Voucher is presented to foreign cus-toms along with its corre-sponding counterfoil upon entry into a foreign country. Counterfoils and vouchers are used in sets. For exam-ple: Counterfoil No. 2 with Voucher No. 2.

Vouchers are the control document of customs and are removed, along with the accompanying General List, at the time of each customs clearance.

The Holder or Authorized Representative must com-plete sections “D” through “F.”

A partial or split shipment may be made by noting in section “F(a)” the line items on the General List that WILL be clearing customs and crossing off the line items that WILL NOT be clearing customs on the General List that is printed on the back of the white voucher.

NOTE: amendments should NEVER be made to the original General List printed on the green cover.

Airway Bill/Bill of Lading/-Flight No. Hand Carry

2015 / 04 / 303 cartons total weight 3,500 lbs

1, 3, 5 - 10, 12, 15

Germany International Sales Meeting

MUST Match the Importation Counterfoil 2

Foreign Customs Stamps Here

11

Holder/Representative MUST sign here

Page 14: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

General ListReverse of Importation Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Importation Voucher.

If your General List is more than one page, Continua-tion Sheets will be attached.

If the General List pages are not printed and/or Con-tinuation Sheets not attached to a voucher, you must photocopy the com-plete list and attach it to the voucher PRIOR to present-ing to customs. This may be the case with some foreign ATA Carnets.

A partial or split shipment may be made by crossing off the line items that WILL NOT be clearing customs on the General List that is printed on the back voucher.

NOTE: amendments should NEVER be made to the original General List printed on the green cover.

12

Page 15: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

C . INTENDED USE OF GOODS/Utilisation prévue des marchandises

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. RE-EXPORTATION VOUCHER No.Volet de réexportation No

a) A.T.A. Carnet No.Carnet A.T.A. No

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

A. HOLDER AND ADDRESS/Titulaire et adresse

FOR CUSTOMS USE ONLY/Réservé à la Douane

H) CLEARANCE ON RE-EXPORTATION/Dédouanement à laréexportation

a) The goods referred to in paragraph F. a) of the Holder'sdeclaration have been re-exported.*/Les marchandisesvisées au paragraph F. a) de la déclaration ci-contre ont étéréexportées*

b) Action taken in respect of goods produced but notre-exported:*/Mesures prises à l'égard des marchandisesreprésentées mais non réexportées:*

..........................................................................................................................c) Action taken in respect of goods NOT produced and NOT

intended for later re-exportation.*/Mesures prises à l'égarddes marchandises non représentées et non destinées à uneréexportation ultérieure.*

..........................................................................................................................d) Registered under reference No.*:/Enregistré sous le No*

..........................................................................................................................e) This voucher must be forwarded to the Customs Office at*:

Le présent volet devra être transmis au bureau de douane de*:

..........................................................................................................................f) Other remarks:*/Autres mentions:*

At/A ........................................................................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

REEXPORTATION

REEXPORTATION

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

F. RE-EXPORTATION DECLARATION/Déclaration de réexportation.

I, duly authorized:/Je soussigné, dûment autorisé:

*a) declare that I am re-exporting the goods enumerated inthe list overleaf and described in the General List underitem No(s)./déclare réexporter les marchandisesénumérées à la liste figurant au verso et reprises à la listegénérale des marchandises sous le(s) No(s)

.................................................................................................................which were temporarily imported under cover ofimportation voucher(s) No(s)./qui ont été importéestemporairement sous le couvert du(des) volet(s)d'importation No(s)

.................................................................................................................of this carnet./du présent carnet

*b) declare that goods produced against the following ItemNo(s). are not intended for re-exportation:/ déclare queles marchandises représentées et reprises sous le(s) No(s)suivant(s) ne sont pas destinées à la réexportation:

.................................................................................................................

*c) declare that goods of the following Item No(s). notproduced, are not intended for later re-exportation:déclare que les marchandises non représentées etreprises sous le(s) No(s) suivant(s) ne seront pasréexportées ultérieurement:

.................................................................................................

*d) in support of this declaration present the followingdocuments/présente à l'appui de mes déclarations, lesdocuments suivants:

.................................................................................................

e) confirm that the information given is true and complete. /certifie justes et complètes les indications portées sur leprésent volet

A.T.A. CARNET CARNET A.T.A.

* If applicable/S'il y a lieu

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N7 (06/04)

VOUCHER

USA Exporters Incorporated 261 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

The Re-exportation Voucher is presented to foreign cus-toms along with its corre-sponding counterfoil upon departure from a foreign country.

The Holder or Authorized Representative must com-plete sections “D” through “F.”

A partial or split shipment may be made by noting in section “F(a)” the line items on the General List that WILL be clearing customs and crossing off the line items that WILL NOT be clearing customs on the General List that is printed on the back voucher.

NOTE: amendments should NEVER be made to the orig-inal General List printed on the green cover.

Foreign Customs will com-plete and sign the shaded section of the Re-exporta-tion Voucher as well as the corresponding counterfoil and will retain the voucher as proof that the goods have been re-exported from the country.

IMPORTANT: Failure to have the Re-exportation Voucher (and correspond-ing counterfoil) validated by foreign customs will result in a customs claim.

The Holder or Authorized Representative signs the lower right-hand section of the voucher.

Airway Bill/Bill of Lading/-Flight No. Hand Carry

3 cartons total weight 3,500 lbs

Port of Entry1, 3, 5-10, 12, 15

2

Foreign Customs Stamps Here

13

Holder/Representative MUST sign here

Page 16: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

General ListReverse of Re-exportation Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Re-exportation Voucher.

If your General List is more than one page, Continua-tion Sheets will be attached.

If General List pages are not printed and/or Continua-tion Sheets not attached to a voucher, you must photo-copy the complete list and attach it to the voucher PRIOR to presenting to cus-toms. This may be the case with some foreign ATA Car-nets.

A partial or split shipment may be made by crossing off the line items that WILL NOT be clearing customs on the General List that is printed on the back of the voucher.

NOTE: amendments should NEVER be made to the original General List printed on the green cover.

14

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Transit Counterfoils

*If applicable / *S'il y a lieu

FO

R U

SE

BY

CU

ST

OM

S O

F C

OU

NT

RY

/CU

ST

OM

S T

ER

RIT

OR

Y O

F T

RA

NS

IT /

SE

RV

É À

LA

DO

UA

NE

DU

PA

YS

/TE

RR

ITO

IRE

DO

UA

NIE

R D

E T

RA

NS

IT

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/ jour)

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

COUNTERFOIL

N9 (04/04)

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

US3/1412101

1

1

2

2

The Blue Transits are used by foreign customs to track goods under its supervision, but which are not in the commerce of that jurisdic-tion.

Transit Counterfoils and their corresponding vouch-ers are generally used only when transiting through one country by land en route to a final destination country or fair ground or airport.

The blue Transit pages may or may not be included in your ATA Carnet depending upon whether or not you indicated at the time of your application that you would be transiting countries.

Upon entry, foreign cus-toms will indicate items being transited in section 1 and will assign a final date that goods must exit under section 2. The Customs official will complete sec-tions 4-7 of both counter-foils no. 1. Customs also completes and removes one corresponding voucher.

Typically very limited time is allowed to complete a transit.

Upon departure from the foreign country, customs will complete the Certificate of Discharge on the second counterfoil (No. 1) and removes the second vouch-er (No. 1).

The Transit Counterfoils will remain in the ATA Carnet as proof that goods were imported and then re-exported from the coun-try through which they were being transited through.

Any sets of counterfoils beyond the number original-ly requested will be marked as “VOID” across the face of the counterfoil and may not be used. If additional sets of Exportation/Re-im-portation counterfoils are required for continued travel, contact your ATA Carnet Service Representa-tive at 1.800.CARNETS (1.800.227.6387).

1-15

1-15

2014 09 21Goods MUST Depart by this Date

VOID

VOID

15

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Transit CounterfoilsReverse

*If applicable / *S'il y a lieu

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) ............................................................................................................................. ........................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

Clearance for transit / Dédouanement pour le transit1. The goods described in the General List under Item No(s).

Les marchandises énumérées à la liste générale sous le(s) No(s) .....................................................................................................................................................................have been dispatched in transit to the Customs Office atont été expédiées en transit par le bureau de douane de ....................................................................................................................................................................................

2. Final date for re-exportation/production to the Customs of goods*Date limite pour la réexportation/la représentation à la douane des marchandises*

3. Registered under reference No.* / Enregistré sous le No*..................................................................................................................................................

Certificate of discharge by the Customs Office of destination / Certificat de décharge du bureau de destination1. The goods specified in paragraph 1 above have been re-exported/produced*/

Les marchandises visées au paragraphe 1 ci-dessus ont été réexportées/représentées*2. Other remarks* / Autres mentions*

......................................................................................................................................................................................................................................................................................

3.

........................................................Customs Office

Bureau de douane

4.

..................................................PlaceLieu

6.

..................................................Signature and Stamp

Signature et timbre

5.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

year / month / day

année / mois / jour/ /

4.

........................................................Customs Office

Bureau de douane

5.

..................................................PlaceLieu

7.

..................................................Signature and Stamp

Signature et timbre

6.

....................... / ................. / .................Date (year/month/day)Date (année/mois/jour)

A.T.A. CARNET / CARNET A.T.A. CARNET No. / Carnet N o

DO NOT REMOVE FROM THE CARNET / NE PAS DÉTACHER DU CARNET

COUNTERFOIL

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

CounterfoilSouche

No.No

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

TRANSIT

FO

R U

SE

BY

CU

ST

OM

S O

F C

OU

NT

RY

/CU

ST

OM

S T

ER

RIT

OR

Y O

F T

RA

NS

IT /

SE

RV

É À

LA

DO

UA

NE

DU

PA

YS

/TE

RR

ITO

IRE

DO

UA

NIE

R D

E T

RA

NS

IT

US3/1412101

VOID

VOID

VOID

VOID

The reverse side of the blue Transit Counterfoils will also contain sets of counter-foils.

If your ATA Carnet applica-tion noted that you would be making more than two tran-sits through foreign coun-tries, these counterfoils will be numbered and may be validated by foreign customs.

Any sets of Transit counter-foils beyond the number originally requested will be marked as “VOID” across the face of the transit counterfoil and may not be used. If addi-tional sets of Transit counter-foils are required for contin-ued travel, contact your ATA Carnet Service Representa-tive at 1.800.CARNETS (1.800.227.6387).

16

Page 19: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

C . INTENDED USE OF GOODS/Utilisation prévue des marchandises

A. HOLDER AND ADDRESS/Titulaire et adresse

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. TRANSIT VOUCHER No.Volet de transit No

a) A.T.A. Carnet No.Carnet A.T.A. No

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

F. DECLARATION OF DISPATCH IN TRANSITDéclaration d'expédition en transit

I, duly authorized:/Je soussigné, dûment autorisé:

a) declare that I am dispatching to:/déclare, expédier à:

...........................................................................................................

...........................................................................................................in compliance with the conditions laid down in the lawsand regulations of the country/customs territory oftransit, the goods enumerated in the list overleaf anddescribed in the General List under item No(s)./dans lesconditions prévues par les lois et règlements du pays/territoire douanier de transit, les marchandises énumérées àla liste figurant au verso et reprises à la liste générale sousle(s) No(s).

...........................................................................................................

...........................................................................................................

b) undertake to comply with the laws and regulations of thecountry/customs territory of transit and to produce thesegoods with seals (if any) intact, and this Carnet to theCustoms Office of destination within the periodstipulated by the Customs./ m'engage à observer les loiset règlements du pays/territoire douanier de transit et àreprésenter ces marchandises, le cas échéant sousscellements intacts, en même temps que le présent carnetau bureau de douane de destination dans le délai fixé parla douane.

c) confirm that the information given is true and complete./certifie justes et complètes les indications portées sur leprésent volet.

TRANSIT

TRANSIT

FOR CUSTOMS USE ONLY/Réservé à la DouaneH) CLEARANCE ON TRANSIT/Dédouanement pour le transita) The goods referred to in the above declaration have been cleared for

transit to the Customs Office at:/Les marchandises faisant l'objet de ladéclaration ci-contre ont été dédouanées pour le transit sur le bureau dedouane de:

..........................................................................................................................b) Final date for re-exportation/production to the Customs*: /Date limite pour

la réexportation/la représentation à la douane, des marchandises*:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .year month day (inclusive)

année mois jour (inclus)c) Registered under reference No.*/Enregistré sous le No*

................................................................................................................d) Customs seals applied*/Scellements douaniers apposés*

................................................................................................................e) This voucher must be forwarded to the Customs Office at*: /Le présent

volet devra être transmis au bureau de douane de:*

................................................................................................................

At/A ...............................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

Certificate of discharge by the Customs Office at destinationCertificat de décharge du bureau de destination

f) The goods referred to in the above declaration have been re-exported/produced*:/Les marchandises faisant l'objet de la déclaration ci-contreont été réexportées/représentées:*

g) Other remarks*:/Autres mentions*:

At/A ...............................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

A.T.A. CARNET CARNET A.T.A.

* If applicable/S'il y a lieu

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N8 (06/04)

VOUCHER

USA Exporters Incorporated 161 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

Transit Counterfoils and Vouchers are used when traveling by land through a country (e.g. traveling from France to Germany but passing through Switzer-land, or from the airport to the fairgrounds)

NOTE: When travelling between European coun-tries, it is not necessary to clear customs thus Transit Counterfoils and Vouchers may not be necessary.

The Holder or Representa-tive should complete sec-tions “D” through “F” of BOTH Transit Vouchers.

Foreign customs will com-plete section “H” of the shaded section of the voucher and will retain the voucher as proof that the goods have entered the country.

The Holder or Authorized Representative must sign the lower right-hand section of the Transit Voucher.

1-15

1-15

5 cartons total weight 6,000 lbs

Transiting to Paris via Train

Foreign Customs Stamps Here

17

Holder/Representative MUST sign here

Page 20: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

General ListReverse of Transit Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Transit Voucher.

If your General List is more than one page, Continuation Sheets will be attached.

If General List pages are not printed and/or Continua-tion Sheets not attached to a voucher, you must photo-copy the complete list and attach it to the voucher PRIOR to presenting to cus-toms. This may be the case with some foreign ATA Car-nets.

For a partial or split ship-ment, line items may be crossed off ONLY on the copy that is printed or attached to the reverse of the voucher.

18

Page 21: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

C . INTENDED USE OF GOODS/Utilisation prévue des marchandises

A. HOLDER AND ADDRESS/Titulaire et adresse

B. REPRESENTED BY*/Représenté par* b) ISSUED BY/Délivré par

United States Council forInternational Business

D. MEANS OF TRANSPORT*/Moyens de transport*

E. PACKAGING DETAILS (Number, Kind, Marks, etc.)*/Détail d'emballage (nombre, nature, marques, etc.)*

FOR ISSUING ASSOCIATION USE / Réservé à l'association émettrice

G. TRANSIT VOUCHER No.Volet de transit No

a) A.T.A. Carnet No.Carnet A.T.A. No

Place .......................................... Date (year/month/day) ...................................Lieu Date (année/mois/jour)

Name ............................................................................................................................Nom

Signature X ....................................................................................................... XSignature

F. DECLARATION OF DISPATCH IN TRANSITDéclaration d'expédition en transit

I, duly authorized:/Je soussigné, dûment autorisé:

a) declare that I am dispatching to:/déclare, expédier à:

...........................................................................................................

...........................................................................................................in compliance with the conditions laid down in the lawsand regulations of the country/customs territory oftransit, the goods enumerated in the list overleaf anddescribed in the General List under item No(s)./dans lesconditions prévues par les lois et règlements du pays/territoire douanier de transit, les marchandises énumérées àla liste figurant au verso et reprises à la liste générale sousle(s) No(s).

...........................................................................................................

...........................................................................................................

b) undertake to comply with the laws and regulations of thecountry/customs territory of transit and to produce thesegoods with seals (if any) intact, and this Carnet to theCustoms Office of destination within the periodstipulated by the Customs./ m'engage à observer les loiset règlements du pays/territoire douanier de transit et àreprésenter ces marchandises, le cas échéant sousscellements intacts, en même temps que le présent carnetau bureau de douane de destination dans le délai fixé parla douane.

c) confirm that the information given is true and complete./certifie justes et complètes les indications portées sur leprésent volet.

TRANSIT

TRANSIT

FOR CUSTOMS USE ONLY/Réservé à la DouaneH) CLEARANCE ON TRANSIT/Dédouanement pour le transita) The goods referred to in the above declaration have been cleared for

transit to the Customs Office at:/Les marchandises faisant l'objet de ladéclaration ci-contre ont été dédouanées pour le transit sur le bureau dedouane de:

..........................................................................................................................b) Final date for re-exportation/production to the Customs*: /Date limite pour

la réexportation/la représentation à la douane, des marchandises*:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .year month day (inclusive)

année mois jour (inclus)c) Registered under reference No.*/Enregistré sous le No*

................................................................................................................d) Customs seals applied*/Scellements douaniers apposés*

................................................................................................................e) This voucher must be forwarded to the Customs Office at*: /Le présent

volet devra être transmis au bureau de douane de:*

................................................................................................................

At/A ...............................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

Certificate of discharge by the Customs Office at destinationCertificat de décharge du bureau de destination

f) The goods referred to in the above declaration have been re-exported/produced*:/Les marchandises faisant l'objet de la déclaration ci-contreont été réexportées/représentées:*

g) Other remarks*:/Autres mentions*:

At/A ...............................................................................Customs Office/Bureau de douane

......................................... ................................................................................Date (year/month/day) Signature and StampDate (année/mois/jour) Signature et timbre

c) VALID UNTIL/Valable jusqu'au

..........................................................................................................................year month day (inclusive)

année mois jour (inclus)

A.T.A. CARNET CARNET A.T.A.

* If applicable/S'il y a lieu

TO BE REMOVED BY FOREIGN CUSTOMS AT THE TIME OF VALIDATIONÀ DÉTACHER PAR LES DOUANES ÉTRANGÈRES LORS DU VISA

N8 (06/04)

VOUCHER

USA Exporters Incorporated 161 BroadwaySuite 2700New York,NY 10006

US3/1412101

Speedy Freight Forwarders, Customs HouseBroker Inc, Joe Smith and John Smith or anyother authorized rep.

EXHIBITIONS AND FAIRS2015 04 30COMMERCIAL SAMPLES

PROFESSIONAL EQUIPMENT

Transit Counterfoils and Vouchers are used when traveling by land through a country (e.g. traveling from France to Germany but passing through Switzer-land, or from the airport to the fairgrounds)

NOTE: When travelling between European coun-tries, it is not necessary to clear customs thus Transit Counterfoils and Vouchers may not be necessary.

The Holder or Representa-tive should complete sec-tions “D” through “F” of BOTH Transit Vouchers.

Foreign customs will com-plete section “H” of the shaded section of the voucher and will retain the voucher as proof that the goods have entered the country.

The Holder or Authorized Representative must sign the lower right-hand section of the Transit Voucher.

Airway Bill/Bill of Lading/Flight No. Hand Carry

1-15

5 cartons total weight 6,000 lbs

Transiting from Paris via Train

Foreign Customs Stamps Here

Holder/Representative MUST sign here

19

Page 22: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

General ListReverse of Transit Voucher

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

3

1

1

1

1

1

1

8

1

1

1

1

3

1

1

1lb

4000lbs

n/a

20lbs

5lbs

62lbs

5lbs

8lbs

5lbs

1.5lbs

9gms

5.5lbs

14ozs

6ozs

.3oz

$2,250.00

$15,000.00

$140,000.00

$7,327.00

$562,000.00

$6,000.00

$1,378.00

$3,989.00

$2,739.00

$156.00

$4,200.00

$13,987.00

$163.52

$315.00

$266.55

JP

US

FR

RU

AT

CN

IT

ES

CN

KR

US

JP

CN

DE

US

US3/1412101

Sony Laptop Model No. 126: Serial No.

7788; 9879; and 3034

1942 Model T Ford red and black VIN

8372JFUWYY6375564

Style Number 110023: Cascading Pear Shaped

Drop Necklace platinum with 1.5 cts

Diamond

Cello and Bow with hard travel case (c.

1920) Rudolph Fisher Sachsen

Midnight Dream: Oil on canvase framed

wood, Artist Randy Slinger (2004)

Samsung Camera Model No. SXW75 Serial No

00237854090

Style No. 676X Wedding Dress Womans Size M

Silk and Taffeta blend, lace overlay

color off white

4 pairs of Manolo Blahnik Harley Slide

Heel Studded Sandal leather and chrome. 1

pair in red, 1 pair in black, 1 pair in

green, 1 pair in silver

Toshiba Computer monitor Model No 7XV99

Serial Number 7893456

Style No. VX98 Faux Fur Bomber Jacket

color leopard print black and tan. (86%

Virgin Wool, 9% Cotton, 2% Silk, 2% Nylon)

18 Karat Gold Emerald 22.66cts pendant

Canon EOS C300 Cinema Camera Body,

Monitor, Handle, A/C Adapter, Charger -

black - S/N: 532450200109

Canon Battery Charger LC-E6 - black -

S/Ns: BGBC, AGAD, BHBC

Sennheiser ew100 G3 Wireless Microphone

Transmitter Freq. Range - G: 566 to 608

Tram TR50 Omnidirectional Lavalier

Condenser Microphone - black - S/N:

80588

26 $759,771.07

0

*** NO CHANGES OR ADDITIONS ABOVE OR BELOW THIS LINE ***

The General List will be printed on the reverse side of each Transit Voucher.

If your General List is more than one page, Continuation Sheets will be attached.

If General List pages are not printed and/or Continua-tion Sheets not attached to a voucher, you must photo-copy the complete list and attach it to the voucher PRIOR to presenting to cus-toms. This may be the case with some foreign ATA Car-nets.

For a partial or split ship-ment, line items may be crossed off ONLY on the copy that is printed or attached to the reverse of the voucher.

20

Page 23: Sample ATA Carnet - roanokegroup.cominfospot.roanokegroup.com/acton/attachment/5777/f-0084/1/... · Sample ATA Carnet ATA Carnet By ... Sony Laptop Model No. 126: Serial No. ... 2%

Green CoverPage 3

NOTES ON THE USEOF A.T.A. CARNET

1. All goods covered by the Carnet shall be entered in columns 1 to 6 ofthe General List. If the space provided for the General List on thereverse of the front cover is insufficient, continuation sheets shall beused.

2. In order to close the General List, the totals of columns 3 and 5 shallbe entered at the end of the list in figures and in writing. If the GeneralList (continuation sheets) consists of several pages, the number ofcontinuation sheets used shall be stated in figures and in writing inBox G. a) of the front cover.

3. Each item shall be given an item number which shall be entered incolumn 1. Goods comprising several separate parts (including spareparts and accessories) may be given a single item number. If so, thenature, the value and, if necessary, the weight of each separate partshall be entered in column 2 and only the total weight and value shouldappear in columns 4 and 5.

4. When making out the lists on the vouchers, the same item numbersshall be used as on the General List.

5. To facilitate Customs control, it is recommended that the goods(including separate parts thereof) be clearly marked with thecorresponding item number.

6. Items answering to the same description may be grouped, providedthat each item so grouped is given a separate item number. If theitems grouped are not of the same value or weight, their respectivevalues, and, if necessary, weights shall be specified in column 2.

7. If the goods are for exhibition, the importer is advised in his owninterest to enter in Box C of the importation voucher the name and add-ress of the exhibition and of its organiser.

8. The Carnet shall be completed legibly and using permanent ink.

9. All goods covered by the Carnet should be examined and registered inthe country/customs territory of depar ture and, for this purpose, shouldbe presented together with the Carnet to the Customs there, except incases where the Customs regulations of that country/Customs territorydo not provide for such examination.

10. If the Carnet has been completed in a language other than that of thecountry /customs territory of importation, the Customs may require atranslation.

11. Expired Carnet and Carnets which the Holder does not intend to useagain shall be returned by him to the issuing association.

12. Arabic numerals shall be used throughout.

13. In accordance with ISO Standard 8601, dates must be entered in thefollowing order: year/month/day.

14. When blue transit sheets are used, the Holder is required to presentthe Carnet to the Customs Office placing the goods in transit andsubsequently, within the time limit prescribed for transit, to the specifiedCustoms "office of destination ". Customs must stamp and sign thetransit vouchers and counterfoils appropriately at each stage.

International Chamber of CommerceWorld Chambers Federation

NOTICE CONCERNANT L’UTILISATIONDU CARNET A.T.A.

1. Toutes les marchandises placées sous le couvert du carnet doivent figurer dans les colonnes 1 à 6 de la liste générale. Lorsque l’espace réservé à celle-ci, au verso de la couverture, n’est pas suffisant, il y a lieu d’utiliser des feuilles supplémentaires .

2. A l’effet d’arrêter la liste générale, on doit mentionnerà la fin, en chiffres et en toutes lettres, les totaux des colonnes 3 et 5. Si la liste générale ( feuilles supplémentaires) comporte plusieurs pages, le nombre de feuilles supplémentaires doit être indiqué en chiffres et en toutes lettres dans la case G. a) de la couverture.

3. Chacune des marchandises doit étre affectée d’un numéro d’ordre qui doit être indiqué dans la colonne 1. Les marchandises comportant des part ies séparées (y compr is les p ièces de rechange et les accessoires) peuvent être affectées d’un seul numéro d'ordre. Dans ce cas il y a lieu de préciser, dans la colonne 2, la nature, la valeur et, en cas de besoin, le poids de chaque parties seuls le poids total et la valeur totale doiven figurer dans les colonnes 4 et 5.

4. Lors de l’établissement des listes des volets, on doit utiliser les mêmes numéros d’ordre que ceux de la liste générale.

5. Pour faciliter le contrôle douanier, il est recommandé d’indiquer lisiblement sur chaque marchandise (y compris les parties séparées) le numéro d’ordre correspondant.

6. Les marchand ises de même nature peuvent être groupées, à condition qu’un numéro d’ordre soit affecté à chacune d’entre elles. Si les marchandises groupées ne sont pas de même valeur ou poids, on doit indiquer leur valeur et, s’il y a lieu, leur poids respectif dans la colonne 2.

7. Dans le cas de marchandises destinées à une exposition, il est conseiIIé à l’importateur, dans son propre intérêt, d’indiquer das la case C du volet d’importation, le nom de l’exposition et le lieu où elle se tient ainsi que le nom et I’adresse de son organisateur.

8. Le carnet doit être rempli de manière lisible et indélébile.

9. Toutes les marchand ises couvertes par le camet do ivent être vérifiées et prises en charge dans le pays/territoire douanier de départ et y être présentées à cette fin, en même temps que le carnet, à la douane, sauf dans les cas où cet examen n’est pas prescrit par la règlementation douanière de ce pays/territoire douanier.

10. Lorsque le carnet est rempli dans une autre langue que celle du pays/territoire douanier d’importation, la douane peut exiger une traduction.

11. Le titulaire restitue à I’association émettrice les carnets périmés ou dont il n’a plus l’usage.

12. Toute indication chiffrée doit être exprimée en chiffres arabes.

13. Conformément à la Norme ISO 8601, les dates doivent être indiquées dans l'ordre suivant: année/mois/jour.

14. Lorsqu'il est fait utilisation des feuillets bleus pour une opération de transit, le titulaire est tenu de présenter son carnet au bureau de mise en transit et ultérieurement dans les délais fixés pour cette opération, au bureau désigné comme «bureau de destination» de l'opération de trans it. Les serv ices douan iers ont l 'obl igat ion de donner aux souches et aux volets de ces feuillets la suite qu'il convient.

Cover Page 3

W.C.F.

N10 (04/04)

General rules of the Cus-toms Convention on the ATA Carnet are found on page 3 of the Green Cover.

21

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Green Cover

Guaranteeing Associations members of WCF / A.T.A. International Guarantee ChainAssociations Garantes membres de la Chaîne de Garantie Internationale WCF / A.T.A.

Box reserved for use by the issuing chamber of commerceCadre réservé à la chambre de commerce émettrice

As a user of this A.T.A. Carnet, you are entitled to the assistance of your A.T.A. contact personat the Chamber of Commerce and Industry of:

Utilisateur de ce Carnet A.T.A., vous bénéficiez de l'assistance de votre correspondant A.T.A.à la Chambre de commerce et d'industrie de:

Mr./ Ms. : M./ M me:

Address:Adresse:

Tel.:

Fax:E-mail:

AFTER FINAL USE, RETURN THIS ATA CARNET TO ROANOKE TRADE, 1475 E. WOODFIELD ROAD, SUITE 500, SCHAUMBURG, IL 60173.

ATTENTION: ATA CARNET DEPARTMENT. À QUI VOUS DEVEZ IMPÉRATIVEMENT RETOURNER CE CARNET APRÈS UTILISATION

ALGERIA (DZ) Chambre Nationale de Commerce, Algiers.

ALBANIA (AL) Union of Chambers of Commerce and Industry of Albania,Tirana.

ANDORRA (AD) Chambre de Commerce, d'Industrie et des Servicesd'Andorre, Andorra la Vella.

AUSTRALIA (AU) Victorian Chamber of Commerce and Industry,Melbourne.

AUSTRIA (AT) Wirtschaftskammer Österreich, Vienna.

ATA Carnets are issued for a specific category(ies) of intended use. See cover page 1 of the Carnet to confirm which applies to your merchandise. Your ATA Carnet may only enter a country which accepts that category. The category codes are: CS --- Commercial Samples, EF --- Exhibitions/Fairs, PE --- Professional Equipment. These three categories are accepted by all Carnet countries, except where indicated.

Problems with Customs?Should you encounter difficulty with foreign customs when us ing an ATA Car ne t , con tac t the l oca l guaranteeing association. Alternatively, contact your Carnet Ser v ice Bureau or v is i t our websi te at h t t p : / /www.merchand isepasspo r t . o rg ; c l i ck "Countries".

Cover Page 4

BELARUS (BY) --- (EF, PE) Belarusian Chamber of Commerce and Industry, Minsk.

(01/21/16)

MOROCCO (MA) --- (EF only) Chambre de Commerce, d'Industrie et de ServicesCasablanca-Settat, Casablanca.

NETHERLANDS (NL) Amsterdam Chamber of Commerce and Industry,Amsterdam.

NEW ZEALAND (NZ) Wellington Regional Chamber of Commerce,Wellington.

NORWAY (NO) Oslo Chamber of Commerce, Oslo.

POLAND (PL) Polish Chamber of Commerce, Warsaw.

PORTUGAL (PT) Camara de Comercio e Industria Portuguesa, Lisbon.

ROMANIA (RO) Chamber of Commerce and Industry of Romania,Bucharest.

SENEGAL (SN) Chambre de Commerce et d'Industrie de la Régionde Dakar, Dakar.

SINGAPORE (SG) Singapore International Chamber of Commerce,Singapore.

SLOVAKIA (SK) Slovak Chamber of Commerce and Industry,Bratislava.

SLOVENIA (SI) Gospodarska Zbornica Slovenije, Ljubljana.

SOUTH AFRICA (ZA) South African Chamber of Business, Saxonwold.

SPAIN (ES) Consejo Superior de las Camaras Oficialesde Comercio, Industria y Navegación de España,Madrid.

SRI LANKA (LK) ICC Sri Lanka, Colombo.

SWEDEN (SE) Stockholm Chamber of Commerce, Stockholm.

SWITZERLAND (CH) Alliance des Chambres de Commerce Suisses, Geneva.

THAILAND (TH) Board of Trade of Thailand, Bangkok.

TUNISIA (TN) --- (EF, PE) Chambre de Commerce et d'Industriede Tunis, Tunis.

TURKEY (TR) Union of Chambers of Commerce, Industry,Maritime Commerce and Commodity Exchangesof Turkey, Ankara.

UNITED KINGDOM (GB) London Chamber of Commerce and Industry, London.

UNITED STATES (US) --- (CS, PE)United States Council for International Business,New York.

RUSSIA (RU) Chamber of Commerce and Industry of the RussianFederation, Moscow.

SERBIA (RS) Chamber of Commerce and Industry of Serbia, Belgrade.

PAKISTAN (PK) --- (PE, EF) National Committee of the International Chamber of Commerce, Karachi.

UKRAINE (UA) Ukrainian Chamber of Commerce and Industry, Kiev.

MONGOLIA (MN) Mongolian National Chamber of Commerce and Industry, Ulaanbaatar.

MONTENEGRO (ME) Chamber of Economy of Montenegro, Pordgorica.

MOLDOVA (MD) Chamber of Commerce and Industry of the Republic of Moldova, Chisinau.

BELGIUM (BE) Fédération Nationale des Chambres de Commerceet d'Industrie de Belgique, Brussels.

BULGARIA (BG)

BOSNIA and HERZEGOVINA (BA)

Bulgarian Chamber of Commerce and Industry, Sofia.

Foreign Trade Chamber of Bosnia and Herzegovina,Sarajevo.

CANADA (CA) --- (CS, EF, certain PE will be accepted)Canadian Chamber of Commerce, Ottawa.

CHINA (CN) --- (EF only) China Council for the Promotion of International Trade,

CROATIA (HR) Croatian Chamber of Economy, Zagreb.

CYPRUS (CY) Cyprus Chamber of Commerce and Industry, Nicosia.

CZECH REPUBLIC (CZ) Economic Chamber of the Czech Republic, Prague.

DENMARK (DK) Danish Chamber of Commerce, Copenhagen.

ESTONIA (EE) Estonian Chamber of Commerce and Industry, Tallinn.

FINLAND (FI) Central Chamber of Commerce of Finland,Helsinki.

FRANCE (FR) Chambre de Commerce et d'Industrie de Paris, Paris.

GERMANY (DE) Deutscher Industrie-und Handelskammertag, Berlin.

GIBRALTAR (GI) Gibraltar Chamber of Commerce, Gibraltar.

GREECE (GR) Athens Chamber of Commerce and Industry, Athens.

HONG KONG, CHINA (HK) Hong Kong General Chamber of Commerce,Hong Kong.

HUNGARY (HU) Magyar Kereskedelmi és Iparkamara, Budapest.

ICELAND (IS) Iceland Chamber of Commerce, Reykjavik.

INDIA (IN) --- (EF only) Federation of Indian Chambers of Commerceand Industry, New Delhi.

IRELAND (IE) Dublin Chamber of Commerce, Dublin.

ISRAEL (IL) Federation of Israeli Chambers of Commerce, Tel-Aviv.

ITALY (IT) Unione Italiana delle Camere di Commercio, Industria,Artigianato e Agricoltura, Rome.

IVORY COAST (CI) Chambre de Commerce et d'Industrie de Côte d'Ivoire,Abidjan.

JAPAN (JP) Japan Chamber of Commerce and Industry, Tokyo.

KOREA (KR) Korea Chamber of Commerce and Industry, Seoul.

LATVIA (LV) Latvian Chamber of Commerce and Industry, Riga.

LEBANON (LB) --- (EF, PE) Beirut Chamber of Commerce and Industry, Beirut.

LITHUANIA (LT) Association of Lithuanian Chambers of Commerce,Industry and Crafts, Vilnius.

MACEDONIA (MK) Economic Chamber of Macedonia, Skopje.

MALAYSIA (MY) Malaysian International Chamber of Commerce

MADAGASCAR (MG) Fédération des Chambres de Commerce et d’ Industriede Madagascar, Antananarivo

and Industry, Kuala Lumpur.

MALTA (MT) Malta Chamber of Commerce, Valletta.

Beijing.

LUXEMBOURG (LU) Fédération Nationale des Chambres de Commerceet d'Industrie de Belgique, Brussels.

CHILE (CL) Santiago Chamber of Commerce, Santiago.

MACAO, CHINA (MO) Macao Chamber of Commerce, Macao.

UNITED ARAB EMIRATES (AE) --- (EF only)Dubai Chamber of Commerce and Industry, Dubai

MEXICO (MX) Mexico City National Chamber of Commerce, Mexico, D.F.

BAHRAIN (BH) --- (EF) Bahrain Chamber of Commerce and Industry, Manama.

MAURITIUS (MU) --- (All goods except jewelry)Mauritius Chamber of Commerce and Industry,Port Louis.

INDONESIA (ID) --- (EF, PE) Indonesian Chamber of Commerce and Industry (KADIN), Jakarta.

Page 4

Roanoke Trade1475 E. Woodfield Road, Suite 500Schaumburg, IL 601731.800. [email protected] / www.RoanokeTrade.com/ATA-Carnet

22

Should you encounter difficulty with foreign customs when using an ATA Carnet, contact the local guaranteeing association. Alternatively, contact our ATA Carnet Customer Service Teamat 1.800.CARNETS (1.800.227.6387) or visit our websiteat www.RoanokeTrade.com/ATA-Carnet

The countries in which the ATA Carnet may be used and their Guaranteeing Associations are located are listed on page 4 of the Green Cover.

The ATA Carnet is the prop-erty of the USCIB. There-fore, upon final use of the ATA Carnet, it should be returned to Roanoke Trade at the address noted on the document. Roanoke Trade will review your document and will forward to USCIB for closure.

Failure to return the ATA Carnet will delay final closure of the document and could result in a foreign customs claim.

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Clearing U.S. Customs

Depart the U.S. – Use Green Cover and yellow Exportation counterfoil No. 1.1. At initial departure, the Holder/authorized representative signs the Green Cover in box “J.” and presents the ATA Carnet to U.S. Customs & Border Protection (CBP) for activation upon its first use. CBP must validate the ATA Carnet by signing and stamping Section H: “Certificate by Customs at Departure” on the Green Cover. If not validated, Foreign Customs may deny entry of the goods. Completion of Section H and validation of an Exportation counter-foil eliminates the need to complete a Certificate of Registration, CBP form 4455.2. CBP notes the items leaving the U.S. in section box 1 of the yellow exportation counterfoil and stamps box 7. It is the Holder’s responsibili-ty to ensure that CBP has indicated the correct items, especially in cases of partial or split shipments. For details on the correct annota-tions for partial or split shipments please see page 12.

Reenter the U.S. – Use the yellow Re-importation counterfoil bearing the same number as the yellow Exportation counterfoil used at the time of departure.Sec.148.11 of the CBP Code states “All articles brought into the United States by any individual shall be declared to a Customs officer at the port of first arrival...” CBP typically allows the goods to reenter the U.S. even if the ATA Carnet has expired. The expiration date only limits entry into foreign countries.1. Present the ATA Carnet to CBP at the time of re-entry.2. CBP indicates only the items re-entering in box 1 on the yellow re-importation counterfoil and stamps box 6.3. IMPORTANT. Upon returning to the U.S., the Re-importation counterfoil must be validated by CBP. This is the last line of defense in resolving a possible claim from foreign Customs.

Clearing Foreign Customs

Enter a Foreign Country – Use the white Importation counterfoil and its corresponding Importation voucher.1. Complete sections D-F on the voucher. Indicate only the items that are entering the country in box F(a). Specify in box F(b) the intended use of the ATA Carnet: name of the trade show or exhibi-tion, or sales meeting, or television show.2. Sign and date the voucher.3. Present the ATA Carnet to customs at the time of entry.4. Note on the counterfoil box 1 only the items that are entering.5. Foreign Customs has the right to restrict any visit to less than

one year regardless of the ATA Carnet expiration date. Be sure to comply with the date noted in box 2 of the counterfoil: “Final Date for Reexportation/production to the Customs of goods.”6. Foreign Customs validates the counterfoil and the voucher, removing and retaining the voucher for their records.

Depart a Foreign Country – Use the white Re-exportation counterfoil and voucher that has the same number as the most recently used Importation counterfoil and voucher.1. Complete sections D-F of the Re-exportation voucher. Indicate the items that are departing in box F(a). Also indicate the corre-sponding Importation voucher number in the second part of box F(a). Complete Section F(b, c, d), if applicable.2. Sign and date the voucher.3. Present the ATA Carnet to customs at the time of departure.

4. Note the items that are departing from the foreign country in box 1 of the Re-exportation counterfoil.5. Foreign Customs validates the counterfoil and voucher, retain-ing the voucher to match with the Importation voucher.6. For items sold abroad, it is advisable to obtain a customs receipt, which indicates the ATA Carnet No. and the amount of duties/taxes/penalties paid. 7. Use in the EU: Customs authorities in the European Union will not validate ATA Carnets for goods moving between EU member countries. Before departure from the EU, assure validation of the Re-exportation counterfoil and voucher.8. Penalties: All items not re-exported whether lost, stolen, or destroyed, are subject to all applicable duties, taxes, and possible penalties. Holders who fail to have the Carnet validated at depar-ture may be charged a regularization fee by Foreign Customs.

Transiting a Country (if applicable)Use two blue Transit counterfoils (both bear the same number) and vouchers (both bear the same number).Transits are used when merchandise travels by land through a country that lies between the country of departure and the next country of entry (for example: leaving Germany to go to Italy, but passing through Switzerland).Transit may also be used when a Holder is attending an exhibition/-fair or for traveling between customs jurisdictions in the same country.

At the Time of Entry

1. Complete boxes D-E on both Transit vouchers. Indicate in box F(a) the customs port from which the goods will exit.2. Indicate only the items that are transiting in the lower half of box F(a).3. Sign and date the vouchers.4. Present the ATA Carnet to customs at the port of entry.5. Foreign Customs notes the items, port of dispatch, and final date for re-exportation on the counterfoil under “Clearance for Transit” boxes 1 & 2. Be sure to comply with this date and the port of departure.6. Customs completes boxes 4-7 on both counterfoils and box H of the first voucher. One voucher will be removed.

At the Time of Departure

1. Present the ATA Carnet to customs at the port of discharge.2. Customs at the port of discharge will complete the “Certificate of Discharge” on the second counterfoil and box H of the second voucher and then remove the second voucher.3. The transit is complete when boxes 3-6 of the second counter-foil have been validated and both vouchers have been removed by customs.

Final Return to the U.S.

1. Your ATA Carnet is the property of USCIB. Upon completion of the final trip, the original ATA Carnet including all used and unused counterfoils and vouchers, must be returned to Roanoke Trade via receipted mail. Keep a copy of the entire ATA Carnet, including the unused sheets for your records.2. If you have any questions please contact your ATA Carnet Service Representative at 1.800.CARNETS (1.800.227.6387) or [email protected]

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ATA Carnet by Roanoke

rev 03/16

The ATA Carnet is an international customs document that allows temporary entry tax and duty free into over 100 foreign countries.

ATA Carnets are guaranteed by national groups which manage the system. The U.S. Council for International Business (USCIB) was appointed by the Treasury Department and by U.S. Customs in 1968 to operate the ATA Carnet system in the United States, and in 1978 Roanoke Trade was selected as the first ATA Carnet service provider for USCIB.

For more details on ATA Carnets by Roanoke please visit our website at www.RoanokeTrade.com/ATA-Carnet.

Contact us at 1.800.CARNETS (1.800.227.6387) or [email protected]

Corporate Office:

1475 E. Woodfield Road, Suite 500Schaumburg, IL 60173

ATA Carnet Regional Offices and Pick Up Locations:

Charleston, SCOne Poston Road, Suite 100Charleston, SC 29407(843) 723-5880

Chicago, IL1475 E. Woodfield Road, Suite 500Schaumburg, IL 60173(847) 969-1420

Houston, TX11 Greenway Plaza, Suite 105Houston, TX 77046(713) 528-6464

Los Angeles, CA100 W. Broadway, Suite 100Long Beach, CA 90802(562) 256-1914

Miami, FL7600 NW 19th Street, Suite 101Miami, FL 33126(305) 592-8988

New York, NY61 Broadway, Suite 2700New York, NY 10006(212) 747-1800

San Francisco, CA533 Airport Boulevard, Suite 434Burlingame, CA 94010(415) 421-1381

ATA Carnet By Roanoke

A service provider for the U.S. Council for International Business (USCIB)

ATL Pick upAtlanta GACall 1.800.CARNETS (1.800.227.6387)to coordinate a pick up in ATL

DFW Pick upDallas Fort Worth, TXCall 1.800.CARNETS (1.800.227.6387)to coordinate a pick up in DFW