Form ITA-4156P Affidavit for Application for TRQ License. Cotton Shirti

OMB No: 0625-0260
E xpires: 12/31/2007

ITA-4156P

A F F ID A V IT
FO R A PPL IC A TION FO R TR Q LICE N SE
C O T T O N SH IR T IN G F A B R IC
TARIFF RATE QUOTA 2008
If da ta p ro vid ed is to b e trea ted a s B u sin ess C o n fide n tia l, p lea se ind ica te p ro m in en tly a cro ss to p o f fo rm
Company Name:
Company Address:

_______________________
_______________________
_______________________
_______________________

Contact Name: ______________________
Contact Address: ______________________
______________________
______________________
Contact Telephone Number: ________________

_______________________

Contact Fax Number:

Company Federal Tax
Identification Number:

Contact E-mail Address

______________ __

________________

Please check if men’s and boys’ cotton shirts are cut and sewn in the United States in Calendar Year 2007.
and/or
P lea se ch eck b o x if men’s and boys’ cotton shirts w ere cu t a n d se w n b y a co n tra cto r in 2 0 0 7 a n d yo u h a d title to the fa b ric.

Quantity of imported woven fabrics of cotton containing 85 percent or m ore by weight of cotton of the kind described in HTS 9902.52.08 through
9902.52.19 purchased in calendar year 2000 for use in the cutting and sewing of men’s and boys’ cotton shirts in the United States

______________________Square Meters.
Date of Purchase:
(a) the invoice date if the manufacturer is not the importer of record.______________________________________
_______________________________________________________________________________________________
(b) the date of entry if the manufacturer is the importer of record._________________________________________
_______________________________________________________________________________________________
Manufacturing facilities producing men’s and boy’s shirts of cotton containing 85 percent or more by weight of
cotton during calendar year 2000.
Names and Address of Plant Producing
Contractors and Location of Plants
For listing additional plants and/or contractors, add additional pages.
Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the
matters set out in the application, certify that the information contained therein is complete and accurate, signed and sworn before a
Notary Public, and acknowledging that generally, pursuant to 31 U.S.C. 3729 persons providing false or fraudulent claims, and
pursuant to 18 U.S.C. 101, persons making materially false statement to representations, are subject to civil or criminal penalties,
respectively.

Signature of Representative

Date

Signature of Notary

Date

Public reporting for this collection of information is estimated to average 1 hours per response, including the time for reviewing instructions, and completing and
reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent allowed under
the Freedom of Information Act. Not withstanding any other provision of the law, no person is required to respond to nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless the collection of information displays a current
valid OMB control Number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to the Reports Clearance officer, International Trade Administration, Department of Commerce, Room 4001, 14th and Constitution Avenue, N.W.,
Washington, DC 20230.