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pdfDEPARTMENT OF HOMELAND SECURITY
OMB No. 1651-0091
Expires 05/31/2013
U.S. Customs and Border Protection
ANDEAN TRADE PREFERENCE ACT (ATPA) DECLARATION
19 CFR Ch.1; §10.207 thru §10.211
I,
hereby declare that the articles described below (a) were produced or manufactured in
(Name)
(Country)
by means of processing operations performed in that country as set forth below and were also subjected to processing operations in the other
beneficiary country or countries (including the Commonwealth of Puerto Rico, the U.S. Virgin Islands, and any CBI beneficiary country) as set forth below and (b) incorporate
materials produced in the country named above or in any other beneficiary country or countries (including the Commonwealth of Puerto Rico, the U.S. Virgin Islands, and any CBI
beneficiary country) or in the customs territory of the United States (other than the Commonwealth of Puerto Rico) as set forth below:
Description
of Articles
Invoices
Date
Number
Date
Address
Quantity
Processing operations
performed on articles
Direct costs
Description of processing
of processing
operations and
operations
country of processing
Signature
Material produced in a beneficiary country
or in the U.S.
Description of material,
Cost or
production process, and
value of
country of production
material
Title
CBP Form 17 (02/11)
ANDEAN TRADE PREFERENCE ACT (ATPA) DECLARATION
CONTINUATION
Invoices
Date
Number
Initials
Description
of Articles
Quantity
Processing operations
performed on articles
Direct costs
Description of processing
of processing
operations and
operations
country of processing
Page
of
Material produced in a beneficiary country
or in the U.S.
Description of material,
Cost or
production process, and
value of
country of production
material
CBP Form 17 (02/11)
File Type | application/pdf |
File Title | Microsoft Word - CBP Form 17, ATPA Declaration |
Author | mhughes |
File Modified | 2011-05-20 |
File Created | 2011-05-20 |