Form 357 Application for Permit to Import Controlled Substances f

U.S. Department of Justice / Drug Enforcement Administration

OMB APPROVAL
No. 1117 - 0013

APPLICATION FOR PERMIT TO IMPORT CONTROLLED SUBSTANCES
FOR DOMESTIC AND/OR SCIENTIFIC PURPOSES
PURSUANT TO SECTION 1002, TITLE III, P.L.91-513
( Read instructions on reverse before completing)

TO:

DRUG ENFORCEMENT ADMINISTRATION
INTERNATIONAL DRUG UNIT (ODOI)
WASHINGTON, D.C. 20537

See reverse for Privacy Act
DATE
IMPORTER’S APPLICATION NUMBER

Application is hereby made pursuant to the provisions of the Controlled Substances Import and Export
Act and the regulations prescribed thereunder for a permit to import as follows:
1. NAME OF FOREIGN EXPORTER

3. FOREIGN PORT OF EXPORTATION

2. ADDRESS OF FOREIGN EXPORTER

4. PORT OF ENTRY (U.S. Customs port where shipment
will clear)

6a. NAME AND QUANTITY OF DRUG PREPARATION
TO BE IMPORTED (Enter names as shown on labels;
numbers and sizes of packages; strength, CSA Drug
Code, and NDC Number)

7a. ASSIGNED QUOTA FOR THIS
YEAR

6b. CONTROLLED SUBSTANCE CONTENT OF DRUG
OR PREPARATION TO BE IMPORTED expressed as
acid, base or alkaloid (Enter name of controlled
substance contained in the drug; compound, or
preparation)

7b. TOTAL KG. AUTHORIZED ON
PERMITS THIS YEAR

5. LATEST DATE SHIPMENT WILL
LEAVE FOREIGN PORT

6c. DATE IMPORTED AND ACTUAL
QUANTITY (Completed by
registrant at time of import)
DEA PERMIT No.:

7c. KG OF 7b. IMPORTED TO
DATE

7d. STOCK ON HAND & DATE

8. IF SUBSTANCE(S) WILL BE IMPORTED FOR SCIENTIFIC PURPOSES ONLY, PLEASE COMPLETE:
I hereby certify the above controlled substances are imported exclusively for scientific purposes, pursuant to 21 CFR 1312.13(a)(4) (see reverse), as follows:

Signature of Certifying Individual
NAME OF IMPORTER

ADDRESS OF IMPORTER

IMPORTER’S TELEPHONE NO.

DEA REGISTRATION NO.

SIGNATURE AND TITLE OF PERSON MAKING APPLICATION

NOTICE : Controlled Substances may not be imported by mail or parcel post.
APPROVED IMPORT PERMIT NUMBER

DEA USE
ONLY
DEA Form
(May 1989)

- 357

DATE IMPORT PERMIT NUMBER ISSUED
Previous editions are OBSOLETE.

INFORMATION AND INSTRUCTIONS, DEA-357
This application must be completed in triplicate. Original is sent to DEA. See instruction 6c for copies
two and three.
Importation of any controlled substance listed in schedule I or II or any narcotic drug listed in schedule
III, IV, or V should be made pursuant to 21 CFR, Section 1312.13, parts (a) and (b) or any schedule III
through V nonnarcotic controlled substance as specifically designated by 21 CFR, Section 1312.30.
Permits when issued will be mailed to the importer at the address shown on the application unless
contrary instructions are received. Application should be made in the name of the official whose
registration is on file with the Drug Enforcement Administration.
6. Identification of drugs to be imported and the controlled substance content should be entered on the application in the
following manner:
6a. NAME AND QUANTITY OF DRUG OR
PREPARATION TO BE IMPORTED AND
NUMBER OF CONTAINERS

6b. CONTROLLED SUBSTANCE CONTENT OF DRUG
OR PREPARATION TO BE IMPORTED (expressed
as acid, base or alkaloid, not salt)

1 vial x 0.1 mg Cocaine d3

Cocaine

0.1 mg

1 vial x 5.0 mg Phen-d5-cyclidine HC1

Phencyclidine

4.35 mg

250 Cases containing a total of 15,100 kg
Crude Indian Opium (10% AMA)

Opium

1,500 kg AMA

3,600 kg Poppy Straw Concentrate 75-80% AMA

Poppy Straw Concentrate

2,700-2,800 kg AMA

6c. The following information must be entered in block 6c of copies 2 and 3 at the time of import:
(1) DEA Import Permit No. and (2) actual quantity and date received. Copy 2 is sent to DEA.
Copy 3 is retained by importer.
7. Importers of crude opium, poppy straw, concentrate of poppy straw, and coca leaves complete this section.
8. If applicable, the scientific uses to which the drug is to be put after import should be stated briefly, such as:
“For chemical and clinical study of its properties and suitability for medical distribution.”
“For use in laboratory and pilot plant studies of methods of extraction (or production) of its
component alkaloids.” Etc.

PRIVACY ACT INFORMATION
Authority: Section 1002 of the Controlled Substances Act of 1970 (PL 91-513).
Purpose: Control importation of certain Controlled Substances into the United States.
Routine Uses: The Controlled Substances Act Registration Records produces special reports required for statistical
analytical purposes. Disclosures of information from this system are made to the following categories
of users for the purposes stated:
A. Other Federal law enforcement and regulatory agencies for law enforcement and regulatory purposes.
B. State and local law enforcement and regulatory agencies for law enforcement and regulatory purposes.
C. Persons registered under the Controlled Substances Act (Public Law 91-513) for purposes of verifying
the registration of customers and practitioners.
Effect: No permit will be issued.

Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control
number. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,
to the FOI and Records Management Section, Drug Enforcement Administration, Washington, D.C. 20537; and to the Office of Management and
Budget, Paperwork Reduction Project No. 1117-0013, Washington, D.C. 20503.