Form CBP Form 3499 CBP Form 3499 Application and Approval to Manipulate, Examine, Sample

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
APPLICATION AND APPROVAL TO MANIPULATE,
EXAMINE, SAMPLE OR TRANSFER GOODS

OMB CONTROL NUMBER: 1651-0006
EXPIRATION DATE: 11/30/2024

19 CFR 19.8, 19.11, 158.43

GOODS CONSIGNED TO (Name)

GOODS EXPORTED FROM

PORT/PORT CODE AND DATE OF APPLICATION

LOCATION OF GOODS

CARRIER OR SHIP (Name)

BILL OF LADING OR CBP 7512 NO.

IS AREA BONDED?

ENTRY INFORMATION

Number:

Yes

No

Warehouse

Consumption

Date:

PERMISSION IS REQUESTED TO (Describe the complete operation to be performed under CBP supervision on the goods listed below):

MARKS AND NUMBERS

DESCRIPTION

FOR CBP USE ONLY
MANIPULATED VALUE

SIGNATURE OF APPLICANT

APPROVED
DATE

14. SIGNATURE AND TITLE OF APPROVING CBP OFFICER
See Page 2 for the Customs and Border Protection Officer's Report and the Paperwork Reduction Act Notice.

CBP Form 3499 (05/24)

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CUSTOMS AND BORDER PROTECTION OFFICER'S REPORT
MANIPULATION COMPLETED AS REQUESTED: When goods are repacked the CBP (warehouse) officer
will report hereon the marks and numbers of packages repacked and the marks and numbers of packages
and the weights or gauge of same after repacking.

Date:

CBP OFFICER NAME AND TITLE
Last Name

First Name

MI

PAPERWORK REDUCTION ACT STATEMENT: An agency may not conduct or sponsor an information collection and a person is not
required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for
this collection is 1651-0006. Obligation to respond is required to obtain benefits. The estimated average time to complete this application is 6
minutes. If you have any comments regarding the burden estimate you can write to PRA Clearance Officer, U.S. Customs and Border
Protection, Office of Regulations and Rulings, 90 K Street NE, Washington DC 20002.

CBP Form 3499 (05/24)

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