TD F 93.04 Trade Sanctions Reform and Export Enhancement Applicatio

Application Summary
Reference Number:None

TSRA License Application

Generated on 6/28/2021

Application Information
License Application
Medicine
6/28/21
Iran

Application Type:
Product Category:
Request Date:
Country Program:

Previous/Current Licenses:

Export Value:
Letter of Credit Originating
in Iran or Sudan:
Reference Number:

Linked Case ID:

General
None

Expiration Date:

Exporters
Institution Name:
Address:
City:
Postal Code:
Phone:
Web Address:
Contact Name:
Address:
City:
Postal Code:
Phone:
Email Address:

Sample
Sample
Sample
20005
O: 1-202-000-0000

Exporter Role:

Applicant

State:
Country:

DC
United States
F:

M:

Sample Sample

Title:
State:
Country:

O:
sample@test.com

M:

F:

Importers
Institution Name:
Address:
City:
Postal Code:
Phone:
Web Address:
Contact Name:
Address:
City:
Postal Code:
Phone:
Email Address:

Sample
Sample
Sample

Importer Role:
State:
Country:

O: 971-123 45 6789

M:

Sample Sample

Distributor

Iran
F:

Title:
State:
Country:

O:

M:

F:

Products
Product Name:
Commodity Classification:
CCATS #:
CCATS # Date:
Product Description:

Sample
EAR 99

Classification Contact:
Contact Phone:
Model Number:
Harmonized Tariff Code:

----

Financial Institutions
Institution Name:
Address:
City:

State:

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Reference Number:None

TSRA License Application

Postal Code:

Generated on 6/28/2021

Country:

Legal Institutions
Institution Name:
Address:
City:
Postal Code:
Phone:
Web Address:
Contact Name:
Address:
City:
Postal Code:
Phone:
Email Address:

Exporter Role:
State:
Country:
O:

M:

F:
Title:
State:
Country:

O:

M:

F:

Attachments
CCATS Product Classification Document:
Technical Specifications Document:

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