Department of the treasury

DEPARTMENT OF THE TREASURY UNITED STATES CUSTOMS SERVICE Part 4, C.R.

GENERAL DECLARATION Arrival Departure

Form Approved 08/28/95

1. Name and description of ship

2. Port of arrival / departure

3. Date-time of arrival / departure

MV Amer Fuji CARGO REEFER

NEW ORLEANS

10/01/2005

4. Nationality of ship

5. Name of master

6. Port arrived from / Port of destination

CYPRUS

POPOV FYODOR

COTONOU BENIN

7. Certificate of registry (Port; date; number)

8. Name and address of ship’s agent

LATVIA; JANUARY 19, 2000; 0509

9. Gross register tons

10. Net register tons

11. Position of the ship in the port (berth or station)

AT BERTH - UMC DOCK

12. Brief particulars of voyage (previous and subsequent ports of call; underline where remaining cargo will be discharged)

PORT

DEPARTED

ARRIVED

COTONOU (BENIN)

27/12/04

27/12/04

LOME (TOGO)

26/12/04

26/12/04

ANTWERPEN(BELGIUM)

14/12/04

16/12/04

SAINT PETERSBURG(RUSSIA)

6/12/04

10/12/04

SAN PEDRO N PALMIRA

12/11/04 11/11/04

12/11/04 10/11/04

13. Brief description of the cargo

14. Number of crew (include master)

15. Number of passengers

16. Remarks

NIL

MANIFEST INCOMPLETE

Attached documents (indicate number of copies)

FILED IN ACCORDANCE WITH 4.75CR

17. Cargo Declaration

18. Ship’s Stores Declaration

NIL

NIL

19. Crew List

20. Passenger List

21. Date and signature by master, authorized agent or officer **

NIL

NIL

22. Crew’s Effects Declaration

23. Maritime Declaration of Health *

NIL

NIL

This space for U.S. Customs use only

* **

Only on arrival. Only the Master Licensed Deck Officer, or Purser may sign; documents attached as shown in items 17-22 need not be signed.

(Previous editions may be used)

Customs Form 1301 (3-9-78)

Дата добавления: 2015-11-04