Form DSP-61 Application/License for Temporary Import of Unclassified

OMB APPROVAL NO. 1405-0013
EXPIRATION DATE: 04-30-2018
*ESTIMATED BURDEN: 30 MINUTES

Electronic Form Version Number: 9.3

* PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 30 minutes per response,
including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection.
Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: Department of State (A/ISS/DIR) Washington, D.C. 20520.

U.S. DEPARTMENT OF STATE
DIRECTORATE OF DEFENSE TRADE CONTROLS
APPLICATION/LICENSE FOR TEMPORARY IMPORT OF UNCLASSIFIED DEFENSE ARTICLES
*Transaction Number:

Please note that an Asterisk (*) next to a field in a document designate a mandatory field or block.

No classified information can be included in this application. Classified information must be sent
separately to PM/DDTC in accordance with the Defense Security Service guidelines.
Classified information is being sent under separate cover

To select and open a document, highlight a form and select the "Open Document" button. The document that you selected will open.
Required Documents
DSP-61

Optional Documents
22 CFR § 126.13 Certification Letter
22 CFR § 127.11 Exception to Policy Letter
Contract
Firearms and Ammunitions Import Permit
Firearms and Ammunitions Letter of Explanation
Letter of Intent
Manufacturer Unknown Letter of Explanation
Other Amplifying Data (e.g. Briefing, Proposals)
Precedent (identical/similar) Cases
Product Brochures
Purchase Order
Supplementary Explanation of Transaction (e.g. White Paper)

DSP-61

Included Documents

DSP-61, Page 1

of

SEAL
Signature

DATE ISSUED

License is hereby granted to the applicant for the described commodity to be shipped
to the United States in transit to indicated destination. This license may be revoked,
suspended or amended by the Secretary of State without prior notice whenever the
Secretary deems such action advisable.

LICENSE NO.

LICENSE VALID FOR
MONTHS FROM ABOVE DATE

UNITED STATES OF AMERICA

DEPARTMENT OF STATE

APPLICATION/LICENSE FOR TEMPORARY IMPORT OF UNCLASSIFIED DEFENSE ARTICLES
* 2. DDTC
*1. Date prepared Registration Code
02/15/2018

* 3. Foreign Country from Which Shipped:

* 4. U.S. Port of Import

* 5. Foreign Country of Ultimate Destination:

* 6. U.S. Port of Export

7. U.S. Government Personnel (not PM/DDTC) Familiar
with Commodity

8. Applicant
*Applicant is:

Name

Manufacturer

Exporter

Government

Subsidiary

Agency

*Name

Telephone #

Ext.
*Attention

9. Applicant Contact for Additional Information

*Address

*Name

*City

*Telephone #

Ext.

*State

Add

*ZIP Code

*Telephone #

Ext.

10. Description of Transaction
A.

The identical commodity was licensed to the country in Block 3 under license #

B.

The identical commodity was licensed to other countries under license #

C.

The identical commodity was denied to the country in Block 5 under voided license #

D.

Was never licensed for this applicant

E.

This transaction is in furtherance of agreement #

F.

The transaction is in support of agreement #

* G. This application is related to a disclosure filed with Defense Trade Controls Compliance

No

Yes

Enter Compliance Disclosure Number:

Item

*11. Quantity

*12a. Commodity

*12b.
*12c.

1

Commodity is a
Identify the commodity for which it is intended
None

Unit Type

*14. Value

*14. $ Value

*13. USML Category

Category

Unit Price

Line Item Total

Sub
Add

*15. TOTAL VALUE

$

0

4

DSP-61, Page 2

16.

Owner/End-User of Commodity in Foreign Country from
Which Shipped

of

4

Manufacturer of Commodity

17.

Same as Block 8

*Name

*Name

*Address

*Address

*City

*City

*Country

State

Unknown

ZIP Code

*Country
Add

18.

Consignor in Foreign Country from Which Shipped

19.

Source of Commodity
Same as Block 8

*Name

*Name

*Address

*Address

*City

*City

*Country

State

Same as Block 17

ZIP Code

*Country

Add

Add

20.

Foreign Intermediate Consignee

U.S. Intermediate Consignee

21.

None

Same as Block 8

*Name

*Name

*Address

*Address

*City

*City

*Country

*State

Add

22.

*ZIP Code

Add

Consignee in Foreign Country of Ultimate Destination

*23.

Specific Purpose

None
a.

*Name

Select all that apply:
Overhaul/Repair

Modification/Upgrade

Other (Provide Details)

*Address
*City
*Country
Add

24.

End User in Foreign Country of Ultimate Destination
Same as Block 16

*Name

*Address
*City
*Country

b.

Return to country in Block 16

Transshipment to third country

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*25. Applicant's Statement
I

,

an empowered official (22 CFR 120.25) or an official of a foreign government entity in the U.S., hereby apply for a license to complete the transaction
described above; warrant the truth of all statements made herein; and acknowledge, understand and will comply with the provisions of 22 CFR 120-130,
and any conditions and limitations imposed. If the commodity is firearm or ammunition of U.S. manufacture, I certify that, based on corroborative
evidence, the commodity was not furnished on a grant basis to, or acquired without full payment by, a foreign government under a foreign assistance
program of the U.S. as set forth in 27 CFR 447.57.
I am authorized by the applicant to certify the following in compliance with 22 CFR 126.13:
(1) Neither the applicant, its chief executive officer, president, vice presidents, other senior officers or officials (e.g., comptroller, treasurer,
general counsel) nor any member of its board of directors is:
(a) the subject of an indictment for or has been convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.27 since
the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976); or
(b) ineligible to contract with, or to receive a license or other approval to import defense articles or defense services from, or to receive an
export license or other approval from any agency of the U.S. Government;
(2) To the best of the applicant's knowledge, no party to the export as defined in 22 CFR 126.7(e) has been convicted of violating any of
the U.S. criminal statutes enumerated in 22 CFR 120.27 since the effective date of the Arms Export Control Act, Public Law 94-329,
90 Stat. 729 (June 30, 1976); or is ineligible to contract with, or to receive a license or other approval to import defense articles or
defense services from, or to receive an export license or other approval from any agency of the U.S. Government; and

* 22 CFR 126.13 Certification
a. I am authorized by the applicant to certify that the applicant and all the parties to the transaction can meet in full the conditions of
22 CFR 126.13 as listed above.
b. I am authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the parties of the transaction cannot meet one or
more of the conditions of 22 CFR 126.13 as listed above. A request for an exception to policy, as described in 22 CFR 127.11 of the
ITAR, is attached.
c. I am authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the parties of the transaction cannot meet one or
more of the conditions of 22 CFR 126.13 as listed above. However that party has met the conditions imposed by the Directorate of
Defense Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as described in
22 CFR 127.11 of the ITAR.
d. I am not authorized by the applicant to certify the conditions of 22 CFR 126.13. The applicant and all the parties to the transaction can meet
in full the conditions of 22 CFR 126.13 as listed above. Please see the attached letter from an official that is authorized by the applicant to
certify to the conditions of 22 CFR 126.13.
e. I am not authorized by the applicant to certify the conditions of 22 CFR 126.13. The applicant or one of the parties of the transaction
cannot meet one or more of the conditions of 22 CFR 126.13 as listed above. A request for an exception to policy, as described in
22 CFR 127.11 of the ITAR, and a letter from an official that is authorized by the applicant to certify to the conditions of
22 CFR 126.13 are attached.
f. I am not authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the parties of the transaction cannot meet one
or more of the conditions of 22 CFR 126.13 as listed above. However that party has met the conditions imposed by the Directorate of
Defense Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as described in
22 CFR 127.11 of the ITAR. Please see the attached letter from an official that is authorized by the applicant to certify to the conditions
of 22 CFR 126.13.
Signature
Signature

26. License to be sent to:

[Block is inactive on electronic form.]
Name

Address
City
State
Telephone #

ZIP Code

4

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CONDITIONS OF ISSUANCE AND TEMPORARY IMPORT PROCEDURES
1. This license is issued under the conditions cited in 22 CFR 120-130, including conditions and limitations as applicable to the specific license
authorization.
2. Approval of this license shall not be construed as implying U.S. Government approval or commitment to authorize future temporary imports or
exports of any defense article on the U.S. Munitions List (USML) or any U.S. Government commitment with regard to any proposed manufacturing
license, technical assistance or distribution agreement that may result from a license or other approval.
3. If a license is issued for temporary import of hardware, for return to the country of origin or in-transit to another foreign country, it does not authorize
the temporary import or export (permanent or temporary) from the U.S. of any technical data, unless authorized by an exemption.
4. The issuance of this license does not release the applicant, or anyone acting on their behalf, from complying with other requirement of U.S. law
and regulations.
5. No transfer of title is authorized to occur during the period of temporary import for purposes of overhaul/repair or modification/upgrade into the
U.S. and access to the defense article by foreign persons shall only be in accordance with and for the purpose identified on the license.
6. Licenses for the temporary import of an aircraft or vessel: The applicant when using this license agrees that during its temporary import (1) the
aircraft/vessel will remain demilitarized unless otherwise authorized or will have only those capabilities that are the subject of this license; and
(2) the applicant will maintain the same certification or registry of entry. Also, the aircraft/vessel during its temporary import cannot be used in any
activities (e.g., military activities and transport of USML articles) that are not authorized in this license or by a separate license or exemption under
appropriate U.S. Government regulations.
7. The prior written approval of the Department of State, Directorate of Defense Trade Controls, must be obtained before USML defense articles
exported from the U.S. using a license or other approval, to include an ITAR exemption, may be resold, transferred, diverted, transshipped,
re-exported to, or used in any country, or by any end user or for any end use, other than that described on the license or other approval.
8. The defense articles authorized for temporary import may only be shipped temporarily into a U.S. Port where a U.S. Customs and Border Protection
officer is available. Shipments of defense articles licensed in accordance with the ITAR may not be shipped on a vessel, aircraft, or other means
of conveyance that is owned or operated by, or leased to or from, any of the proscribed countries or areas. The applicant must retain the original
license. Prior to any temporary import and subsequent export, the exporter must present the original license to a U.S. Customs and Border
Protection officer for verification, endorsement and retention and declare the export or entry in accordance with the International Traffic in Arms
Regulations (ITAR) and U.S. Customs and Border Protection procedures using the Automated Export System (AES). Any article temporarily
imported must be exported to the authorized foreign destination prior to the expiration of the license. Otherwise, the applicant must submit a
renewal license at least 60 days prior to the expiration date to renew the authorization.

DISPOSITION OF LICENSE
The final disposition of this license shall be in accordance with 22 CFR123.22(c).

ENDORSEMENT
Indicate below which COMMODITY is BEING EXPORTED and maintain a CONTINUING BALANCE of the remaining value:
SHIPMENT
DATE

QUANTITY

COMMODITY

SHIPMENT VALUE

XTN/ITN

INITIALS

PORT OF
EXIT/ENTRY

TOTAL AUTHORIZED VALUE:

REMAINING BALANCE:

NOTE Continuation of additional shipments must be authenticated by use of continuation sheets in the U.S.Customs handbook.

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