19 CFR 10.8, 10.9, 10.68,
148.1, 148.8, 148.32, 148.37

CBP Form 4455 (06/00)

NOTE:  Certifying officers shall draw lines through all unused spaces with ink or indelible pencil.

DATE

SIGNATURE OF IMPORTER (Print or Type and Sign)

Duty-free entry is claimed for the described articles as having been exported without benefit of drawback and are returned unchanged except as noted: (use reverse if needed)

CERTIFICATE ON RETURN

SIGNATURE OF CBP OFFICER

SIGNATURE OF CBP OFFICER

DATE

PORT

DATE

LADEN under my supervision

EXAMINED

The Above-Described Articles Were:

DATE

SIGNATURE OF OWNER OR AGENT (Print or Type and Sign)

LIST ARTICLES EXPORTED

NAME, ADDRESS, AND ZIP CODE TO WHICH CERTIFIED FORM IS TO BE MAILED (If Applicable)

B/L or INSURED NO.

DATE

(NOTE:  Number of copies to be submitted varies with type of transaction.
       Inquire at Port Director's office as to number of copies required.)

NO.

Form Approved. OMB No. 1651-0010

CERTIFICATE OF REGISTRATION

VIA (Carrier)

Number
Packages

Kind of
Packages

Description

ARTICLES EXPORTED FOR:
ALTERATION*
REPAIR*
USE ABROAD
REPLACEMENT
PROCESSING*

* NOTE: The cost or value of alterations, repairs, or processing

                       abroad is subject to CBP duty.

PORT

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)
OTHER,

(specify)

Any data typed after screen scrolls will not print.

U.S. DEPARTMENT OF HOMELAND SECURITY 

Bureau of Customs and Border Protection

Paperwork Reduction Act Notice:  This request is in accordance with the Paperwork Reduction Act.  The information to be provided is submitted by importers/exporters.  Completion of this form is mandatory and to your benefit.  The estimated average burden associated with this collection of information is 3 minutes per respondent depending on individual circumstances.  Comments concerning the accuracy of this burden estimates and suggestions for reducing this burden should be directed to Bureau of Customs and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0010), Washington, DC 20503.

U.S. DEPARTMENT OF HOMELAND SECURITY Bureau of Customs and Border Protection CERTIFICATE OF REGISTRATION (Note: Number of copies to be submitted varies with type of transaction. Inquire at Port Director's office as to number of copies required.) 19 C F R 10.8, 10.9, 10.68, 148.1, 148.8, 148.32, 148.37. Form Approved O M B Number 16 51-0010 Any Data Typed after screen scrolls will not print. Articles Exported For: * Note: The cost or value of alterations, repairs, or processing abroad is subject to C B P duty. List Articles Exported The Above-Described Articles Were: Certificate on Return NOTE: Certifying officers shall draw lines through all unused spaces with ink or indeliable pencil. Examined LADEN under my supervision Duty-free entry is claimed for the described articles as having been exported without benefit of drawback and are returned unchanged except as noted: Paperwork Reduction Act Notice: This request is in accordance with the Paperwork Reduction Act. The information to be provided is submitted by importers/exporters. Completion of this form is mandatory and to your benefit. The estimated average burden associated with this collection of information is 3 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimates and suggestions for reducing this burden should be directed to Bureau of Customs and Border Protection, Information Services Branch, Washington, D C 2 0 2 2 9, and to the Office of Management and Budget, Paperwork Reduction Project (16 51-0 0 1 0), Washington, D C 2 0 5 0 3. C B P Form 44 55 (06/00)

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