Form CBP Form 7553 CBP Form 7553 Notice of Intent to Export, Destroy or Return Merchandis

OMB No. 1651-0075 Exp. 08-31-2008

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
NOTICE OF INTENT TO EXPORT, DESTROY OR
RETURN MERCHANDISE FOR PURPOSES OF
DRAWBACK
19 CFR 191
1. Exporter or Destroyer
Name

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction
Act. We ask for the information in order to enforce the laws of the United States, to fulfill the U.S. Customs
Regulations, to ensure that the claimant is entitled to drawback, and to have the necessary information which
permits CBP to calculate and refund (or increase) the correct amount of duty and/or tax. Your response is
required to obtain a benefit. The estimated average burden associated with this collection of information is
33 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of
this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and
Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management
and Budget, Paperwork Reduction Project (1651-0075) Washington, DC 20503.
2. Drawback Entry No. 3. Intended Action
5. Drawback Center
4. Intended Date of
Action
Export
Destroy
DATE RECEIVED

6. Contact Name

Address

Address
I.D. Number

Phone

Ext.

FAX
7. Location of Merchandise

14. Import Entry No.

8. Method of Destruction/Location

9. Exporting Carrier Name
(if known)

15. Description of Merchandise (include part number(s))

10. Intended Port of Export

11. Unique Identifier No.

12. T & E No.

13. Country of Ultimate Destination

16. Drawback Amount

17. Quantity & Unit of Measure
18. HTSUS No./Schedule B

19. Drawback to be filled as:
Unused Merchandise Drawback
J1
J2
Manufacturing Drawback

Same Condition Drawback
under NAFTA

Shipped without Consent

Distilled Spirits, Wine or Beer under

Not Conforming to Sample or Specifications

Defective at Time of Importation

Rejected Merchandise
20. Preparer

X
Printed Name

Signature

Date

Title

THIS FORM MUST BE
SUBMITTED WITH THE
DRAWBACK CLAIM

CBP USE ONLY
21. Examination

Waived

Required

24. Printed Name

(Additional information may be required if exam
requested, T & E may be required)

28. Comments/Results of Examination or Witnessing of Destruction.
(Merchandise matches invoice description)

Phone Number

22. Present Merchandise to CBP at:

25. Signature & Badge No.

29. Date Destroyed or Exam Conducted
30. Printed Name of Examining Officer

X
23. Destruction to be Witnessed by
Yes
No
CBP

26. Date

31. Signature & Badge No.

X
27. Port

Phone Number
Ext

Date
CBP Form 7553 (08/01)