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PleaseprintthisforminEnglishusingblueorblackink,pressingfirmlysoallinformationtransferstoallcopies.
Completethedeclarationfullyandlegibly;otherwise,delayandinconveniencemayresultfortheaddressee.
Afalseormisleadingdeclarationmayleadtoafineorseizureoftheitemandadditionalpenalties.
Youmayaddatranslationofthecontentsinalanguageacceptedinthedestinationcountry.
Yourgoodsmaybesubjecttorestrictions.
Itisyourresponsibilitytocomplywithimportandexportregulationsandrestrictions(e.
g.
,quarantine,pharmaceutical,etc.
),andtodeterminewhatdocuments(e.
g.
,commercialinvoice,certificateoforigin,healthcertifi-cate,license,authorizationforgoodssubjecttoquarantinesuchasplant,animal,orfoodproducts,etc.
),ifany,arerequiredinthedestinationcountry.
Checkthecountrylistingsatpe.
usps.
com/text/imm/immctry.
htm,aswellastheUPUListofProhibitedItemsavailableatwww.
upu.
int/customs/en/country_list_en.
pdf.
FROM(Senderinformation)andTO(Addresseeinformation)sections:Enterboththesender'sandaddressee'sfullnameandfulladdressintheblocksprovided.
Incompletenames(e.
g.
,initials)orincompleteaddressentriesmayresultindelayedhandlingbyCustomsand/orthedeliveryoffice.
Providethetelephone/faxnumberoremailaddressofboththesenderandaddressee,assuchinformationwillfacilitatecustomsclearanceanddelivery.
Block1:Enter,ifapplicable,aUSPScorporateaccount(USPSCA)number,federalagen-cyaccountnumber,orPostalServiceaccountnumberforpaymentbyaccount.
Block2:Checkeachboxthatappliestospecifyeachcategoryofeachitem.
Iftheinter-nationalshipmentcontainsdangerousgoodsthatareapprovedformailing,checktheboxfor"DangerousGoods.
"MailabilityinformationforinternationalshipmentsisavailableinPublication52,Hazardous,Restricted,andPerishableMail(chapter6),andinMailingStandardsoftheUnitedStatesPostalService,InternationalMailManual(IMM)Part135.
Block3:EnteranAutomatedExportSystem(AES)InternalTransactionNumber(ITN),AESExemption,orifapplicable,anAESDowntimeCitation.
Oneofthesecodesmustappearinthe"AES/ITN/Exemption"blockbeforethePostalServicewillacceptapackageformail-ing.
Ingeneral,mailpiecescontaininganytypeofgoods(perScheduleBExportCodesatwww.
census.
gov/foreign-trade/schedules/b)valuedatmorethan$2,500,orrequiringanexportlicenseunderU.
S.
law,musthaveanITNissuedbytheU.
S.
CensusBureauoranAESDowntimeCitation,subjecttocertainexceptions.
Mailpiecesthatareexemptfromfil-ingmusthaveanAESExemption.
Regardlessofexemptions,allmailpiecesmusthaveanITNorAESDowntimeCitationiftheyaredestinedtocertaincountriesonwhichtheU.
S.
hasacomprehensiveembargo.
ToobtainanITNandfileelectronicallythroughtheCensusBureau'sAES,orforadditionalinformation,pleasevisitwww.
census.
gov/foreign-trade/aesorcall800-549-0595.
Foradditionalinformation,refertoU.
S.
PostalServicePublication699,SpecialRequirementsforShippingInternationally,andtoIMMSubchapter520.
AESExemption:InordertocomplywiththeU.
S.
CensusBureau'sForeignTradeRegulations,indicate"NOEEI§30.
37(a),"ifapplicable.
"NOEEI§30.
37(a)"maybeusedwhenthevalueofeachclassofgoodsis$2,500orless,ifanexportlicenseisnotrequired.
DoNOTusethisAESExemptionforitemssenttoCuba,Iran,NorthKorea,Sudan,orSyria.
FurtherinformationisavailableinIMMParts526and527.
Block4:Enteradetaileddescriptionofeacharticle—e.
g.
,"men'scottonshirts.
"Generaldescriptions—e.
g.
,"samples,""foodproducts,"or"toiletries"—arenotacceptable.
Ifthereisinsufficientspaceontheformtolistallarticles,useadditionalformsasneeded—onthefirstform(totherightofthebarcode),writethefollowing:"Additionalformsenclosed.
"Important:Oneachsubsequentform,obliteratethetrackingnumberandbar-code.
ThenplaceallformsintoPSForm2976-E(plasticenvelope).
Blocks5–7:Enterthequantity,netweight(inpoundsandounces),andvalue(inU.
S.
dol-lars)ofeacharticle.
Blocks8–9:InBlock8,enter,ifknown,the6-digitHarmonizedTariffSchedulenumber,whichisbasedontheHarmonizedCommodityDescriptionandCodingSystemdevel-opedbytheWorldCustomsOrganization.
InBlock9,enter,ifknown,the"CountryofOrigin,"whichisthecountrywherethegoodsoriginated—e.
g.
,wheretheywerepro-duced/manufacturedorassembled.
Block10:Enterthetotalweight(inpoundsandounces)ofthepackage,includingpack-aging(thetotalweightisusedtocalculatepostage),andenterthetotalvalueinU.
S.
dollars.
Block11:Signanddatetheform.
Yoursignaturecertifiesthatallentriesarecorrectandtheitem(s)beingmailedcontainnoundeclareddangerous,prohibited,orrestrictedcon-tentsperpostal,customs,ordestinationcountryregulations.
Yoursignaturealsocertifiescompliancewithallapplicablefederalexportlicensingandfilingregulationsandconfirmsyourliabilityfortheitem(s)beingmailed.
Blocks12–13:EntertheSender'sCustomsReferenceandImporter'sReference,ifappli-cable.
(TheImporter'sReferencemightbeataxcode,importercode,orVATnumberusedforsalestax.
)Blocks14–16:EntertheLicensenumber,Certificatenumber,and/orInvoicenumber,ifapplicable.
Insertthecompletedform(s)intoPSForm2976-E,CustomsDeclarationEnvelope—CP91.
Encloseanycommercialdocumentsintheenvelope.
Donotfoldtheformsetorwrapitaroundthepackage.
Theentirebarcodeandallinformationmustbevisible.
Removethebackingsheetandaffixtheenvelopetothepackageontheaddressside.
PSForm2976-B,July2013PSN7530-17-000-0377PriorityMailExpressInternationalShippingLabelandCustomsFormINSTRUCTIONSFORCOMPLETINGTHISFORM(Removethispagepriortocompletingtheform.
)InstructionsforcompletingthisformPSForm2976-B,July2013PSN7530-17-000-0377SignatureDate(Month/Day/Year)PriorityMailExpressInternationalShippingLabelandCustomsFormSENDER'SINFORMATIONFrom:Sender'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
ResidentsofPuertoRicoincludeUrbanizationCodeprecededwithURB.
)CityStateZIPCodeTelephone/FaxNumberorEmailAddressADDRESSEE'SINFORMATIONTo:Addressee'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
)PostalCodeCityProvinceCountry(Fullname,notabbreviation)Telephone/FaxNumberorEmailAddress2.
CheckAllThatApply:GiftDocumentsMerchandiseReturnedGoodsCommercialSampleHumanitarianDonationDangerousGoodsOther3.
AES/ITN/Exemption4.
DetailedDescriptionofContents(Enteroneitemperline)5.
QTY6.
WeightLbs.
Ozs.
7.
Value(U.
S.
$)8.
HSTariffNo.
9.
CountryofOrigin10.
TOTAL:11.
Icertifytheparticularsgiveninthiscustomsdeclarationarecorrect.
Thisitemdoesnotcontainanyundeclareddangerousarticles,orarticlesprohibitedbylegislationorbypostalorcustomsregulations.
Ihavemetallapplicableexportfilingrequirementsunderfederallawandregulations.
1–CustomsDeclarationACCEPTANCEINFORMATIONItemWeightInsuredAmount(U.
S.
$)$InsuranceFee(U.
S.
$)$Postage(U.
S.
$)$TotalPostage/Fees(U.
S.
$)$1.
USPSCorporateAcct.
No.
OfficeofOriginDate(Month/Day/Year)TimeScheduledDeliveryDate(Month/Day/Year)DELIVERYINFORMATIONDate(Month/Day/Year)TimePersonSignature12.
Sender'sCustomsReference13.
Importer'sReference14.
LicenseNo.
15.
CertificateNo.
16.
InvoiceNo.
MailingOfficeDateStampPSForm2976-B,July2013PSN7530-17-000-0377SignatureDate(Month/Day/Year)PriorityMailExpressInternationalShippingLabelandCustomsFormSENDER'SINFORMATIONFrom:Sender'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
ResidentsofPuertoRicoincludeUrbanizationCodeprecededwithURB.
)CityStateZIPCodeTelephone/FaxNumberorEmailAddressADDRESSEE'SINFORMATIONTo:Addressee'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
)PostalCodeCityProvinceCountry(Fullname,notabbreviation)Telephone/FaxNumberorEmailAddress2.
CheckAllThatApply:GiftDocumentsMerchandiseReturnedGoodsCommercialSampleHumanitarianDonationDangerousGoodsOther3.
AES/ITN/Exemption4.
DetailedDescriptionofContents(Enteroneitemperline)5.
QTY6.
WeightLbs.
Ozs.
7.
Value(U.
S.
$)8.
HSTariffNo.
9.
CountryofOrigin10.
TOTAL:11.
Icertifytheparticularsgiveninthiscustomsdeclarationarecorrect.
Thisitemdoesnotcontainanyundeclareddangerousarticles,orarticlesprohibitedbylegislationorbypostalorcustomsregulations.
Ihavemetallapplicableexportfilingrequirementsunderfederallawandregulations.
2–CustomsDeclarationACCEPTANCEINFORMATIONItemWeightInsuredAmount(U.
S.
$)$InsuranceFee(U.
S.
$)$Postage(U.
S.
$)$TotalPostage/Fees(U.
S.
$)$1.
USPSCorporateAcct.
No.
OfficeofOriginDate(Month/Day/Year)TimeScheduledDeliveryDate(Month/Day/Year)DELIVERYINFORMATIONDate(Month/Day/Year)TimePersonSignature12.
Sender'sCustomsReference13.
Importer'sReference14.
LicenseNo.
15.
CertificateNo.
16.
InvoiceNo.
MailingOfficeDateStampPSForm2976-B,July2013PSN7530-17-000-0377SignatureDate(Month/Day/Year)SENDER'SINFORMATIONFrom:Sender'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
ResidentsofPuertoRicoincludeUrbanizationCodeprecededwithURB.
)CityStateZIPCodeTelephone/FaxNumberorEmailAddressADDRESSEE'SINFORMATIONTo:Addressee'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
)PostalCodeCityProvinceCountry(Fullname,notabbreviation)Telephone/FaxNumberorEmailAddress2.
CheckAllThatApply:GiftDocumentsMerchandiseReturnedGoodsCommercialSampleHumanitarianDonationDangerousGoodsOther3.
AES/ITN/ExemptionPriorityMailExpressInternationalShippingLabelandCustomsForm3–DispatchNoteOfficeofExchangeCustomsStampCustomsDuty11.
Icertifytheparticularsgiveninthiscustomsdeclarationarecorrect.
Thisitemdoesnotcontainanyundeclareddangerousarticles,orarticlesprohibitedbylegislationorbypostalorcustomsregulations.
Ihavemetallapplicableexportfilingrequirementsunderfederallawandregulations.
ACCEPTANCEINFORMATIONItemWeightInsuredAmount(U.
S.
$)$InsuranceFee(U.
S.
$)$Postage(U.
S.
$)$TotalPostage/Fees(U.
S.
$)$1.
USPSCorporateAcct.
No.
OfficeofOriginDate(Month/Day/Year)TimeScheduledDeliveryDate(Month/Day/Year)DELIVERYINFORMATIONDeclarationbyAddressee:Ihavereceivedtheitem(s)describedonthisnote.
Addressee'sSignatureDate(Month/Day/Year)Pleaseaffixlabelsherewhenrequired.
16.
InvoiceNo.
MailingOfficeDateStampPSForm2976-B,July2013PSN7530-17-000-0377SignatureDate(Month/Day/Year)PriorityMailExpressInternationalShippingLabelandCustomsFormSENDER'SINFORMATIONFrom:Sender'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
ResidentsofPuertoRicoincludeUrbanizationCodeprecededwithURB.
)CityStateZIPCodeTelephone/FaxNumberorEmailAddressADDRESSEE'SINFORMATIONTo:Addressee'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
)PostalCodeCityProvinceCountry(Fullname,notabbreviation)Telephone/FaxNumberorEmailAddress2.
CheckAllThatApply:GiftDocumentsMerchandiseReturnedGoodsCommercialSampleHumanitarianDonationDangerousGoodsOther3.
AES/ITN/Exemption4.
DetailedDescriptionofContents(Enteroneitemperline)5.
QTY6.
WeightLbs.
Ozs.
7.
Value(U.
S.
$)8.
HSTariffNo.
9.
CountryofOrigin10.
TOTAL:11.
Icertifytheparticularsgiveninthiscustomsdeclarationarecorrect.
Thisitemdoesnotcontainanyundeclareddangerousarticles,orarticlesprohibitedbylegislationorbypostalorcustomsregulations.
Ihavemetallapplicableexportfilingrequirementsunderfederallawandregulations.
4–PostOfficeCopyACCEPTANCEINFORMATIONItemWeightInsuredAmount(U.
S.
$)$InsuranceFee(U.
S.
$)$Postage(U.
S.
$)$TotalPostage/Fees(U.
S.
$)$1.
USPSCorporateAcct.
No.
OfficeofOriginDate(Month/Day/Year)TimeScheduledDeliveryDate(Month/Day/Year)DELIVERYINFORMATIONDate(Month/Day/Year)TimePersonSignature12.
Sender'sCustomsReference13.
Importer'sReference14.
LicenseNo.
15.
CertificateNo.
16.
InvoiceNo.
MailingOfficeDateStampPSForm2976-B,July2013PSN7530-17-000-0377SignatureDate(Month/Day/Year)PriorityMailExpressInternationalShippingLabelandCustomsFormSENDER'SINFORMATIONFrom:Sender'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
ResidentsofPuertoRicoincludeUrbanizationCodeprecededwithURB.
)CityStateZIPCodeTelephone/FaxNumberorEmailAddressADDRESSEE'SINFORMATIONTo:Addressee'sLastNameFirstNameMIBusinessName(Ifapplicable)Address(Number,street,suite,apt.
,P.
O.
Box,etc.
)PostalCodeCityProvinceCountry(Fullname,notabbreviation)Telephone/FaxNumberorEmailAddress2.
CheckAllThatApply:GiftDocumentsMerchandiseReturnedGoodsCommercialSampleHumanitarianDonationDangerousGoodsOther3.
AES/ITN/Exemption4.
DetailedDescriptionofContents(Enteroneitemperline)5.
QTY6.
WeightLbs.
Ozs.
7.
Value(U.
S.
$)8.
HSTariffNo.
9.
CountryofOrigin10.
TOTAL:11.
Icertifytheparticularsgiveninthiscustomsdeclarationarecorrect.
Thisitemdoesnotcontainanyundeclareddangerousarticles,orarticlesprohibitedbylegislationorbypostalorcustomsregulations.
Ihavemetallapplicableexportfilingrequirementsunderfederallawandregulations.
5–Sender'sCopyACCEPTANCEINFORMATIONItemWeightInsuredAmount(U.
S.
$)$InsuranceFee(U.
S.
$)$Postage(U.
S.
$)$TotalPostage/Fees(U.
S.
$)$1.
USPSCorporateAcct.
No.
OfficeofOriginDate(Month/Day/Year)TimeScheduledDeliveryDate(Month/Day/Year)DELIVERYINFORMATIONDate(Month/Day/Year)TimePersonSignature12.
Sender'sCustomsReference13.
Importer'sReference14.
LicenseNo.
15.
CertificateNo.
16.
InvoiceNo.
MailingOfficeDateStampPSForm2976-B,July2013PSN7530-17-000-0377ReverseofPage5of5,Senders'sCopyPriorityMailExpressInternationalShippingLabelandCustomsFormServiceGuarantee:ThisserviceagreementdoesnotcoverPriorityMailExpressInternationalshipmentstocountriesnoteligiblefordate-specificdelivery.
Italsoexcludesinternationalshipmentsdelayedduetocustomsinspections.
IfthemailersubmitsanitematadesignatedUSPSPriorityMailExpressInternationalacceptancelocationonorbeforethespecifieddeposittimefordate-specificdeliverytotheaddressee,thedestinationpostwilldeliverorattemptdeliverytotheaddresseeoragentbeforetheapplicableguaranteeddeliverydate.
Thesignatureoftheaddressee'sagentordeliveryemployeeisrequiredupondelivery.
Ifthedestinationpostdoesnotdeliverorattemptdeliverybytheguaranteeddeliverydateandthemailerfilesaclaimforarefund,theU.
S.
PostalServicemayrefundthepostage,unlessthedelaywascausedbythefollowing:properdetentionforlawenforcementpurposes;strikeorworkstoppage;latedepositofitem,forwarding,return,incorrectaddress,orincorrectpostcode;delayorcancellationofflights;governmentalactionbeyondthecontrolofthePostalService,destinationpost,oraircarriers;war,insurrection,orcivildisturbance;breakdownsofasubstantialportionoftheUSPSordestinationposttransportationnetworkresultingfromeventsorfactorsoutsidethecontrolofthePostalServiceorforeignpostaladministration;oractsofGod.
Fordetails,seeMailingStandardsoftheUnitedStatesPostalService,DomesticMailManual(DMM)Part114,andMailingStandardsoftheUnitedStatesPostalService,InternationalMailManual(IMM)Part942.
Whenthedestinationpostaladministrationcannotdeliveranitemonthefirstattempt,itleavesanoticefortheaddressee,orfollowsitsdomesticdeliverystandards.
Ifitcannotdelivertheitemonthesecondattempt,itreturnstheitemtothesenderatnoadditionalpostage.
PleaseconsultyourlocalPriorityMailExpressdirectoryforinformationonPriorityMailExpressInternationalservices.
SeetheIMMfordetails.
InsuranceCoverage:ThePostalServiceprovidesinsuranceonlyinaccordancewithpostalregulationsintheIMMforinternationalshipments.
TheIMMsetsforthspecifictypesoflossesthatarecovered,thelimitationsofcoverage,termsofinsurance,conditionsofpayment,andadjudicationprocedures.
Fordetails,seetheIMM,whichisavailableatpe.
usps.
com.
TheIMMconsistsoffederalregulations,andUSPSpersonnelareNOTauthorizedtochangeorwaivetheseregulationsorgrantexceptions.
LimitationsprescribedintheIMMprovide,inpart,thefollowing:ThePostalServiceinsuresthecontentsofPriorityMailExpressInternational"merchandise"items(with"merchandise"definedbypostalregulations)againstloss,damage,ormissingcontents.
ThePostalServiceincludes,atnoadditionalcharge,upto$200coverageforinternationalshipmentscontainingmerchandise.
Thesendermaypurchaseadditionalmerchandiseinsurancecoverageabove$200,uptoamaximumof$5,000.
SeetheIndividualCountryListingsintheIMMformerchandiseinsurancelimits.
ThePostalServiceinsures"nonnegotiabledocuments"(asdefinedbypostalindemnityregulations)againstloss,damage,ormissingcontentsupto$100pershipmentfordocumentreconstruction,subjecttoadditionallimitationsformultiplepieceslostordamagedinasinglecatastrophicoccurrence.
Documentreconstructioninsuranceprovidesreimbursementforthereasonablecostsincurredinreconstructingduplicatesofnonnegotiabledocumentsmailed.
Documentreconstructioninsurancecoverageabove$100peritemisnotavailable.
Themailershouldnotattempttopurchaseadditionaldocumentinsurance,becauseadditionaldocumentinsuranceisvoid.
ThePostalServiceinsures"negotiableitems"(definedbypostalregulationsasitemsthatcanbeconvertedtocashwithoutresorttoforgery),currency,orbullionuptoamaximumof$15peritem.
Insurancecoveragemayvarybycountryandmaynotbeavailabletosomecountries.
Insuranceforloss,damage,ormissingcontentscoverstheactual(depreciated)valueofthecontentsatthetimeofmailingorthecostofrepairs,nottoexceedthelimitfixedfortheinsurancecoverageobtained.
EXCEPTIONS:ThefollowingexceptionsapplytoPriorityMailExpressInternationalshipments:ThePostalServicedoesnotpayindemnityforthefollowingcontents:coins;banknotes;currencynotes,includingpapermoney;securitiesofanykindpayabletobearer;traveler'schecks;platinum,gold,andsilver;preciousstones;jewelry;watches;andothervaluableorprohibitedarticles.
SeetheIMMforcompleteregulations.
ThePostalServicedoesnotprovidecoverageforconsequentiallossesduetoloss,damage,ordelayofPriorityMailExpressInternationalitems,orforconcealeddamage,spoilageofperishableitems,prohibitedarticles,andarticlesimproperlypackagedortoofragiletowithstandnormalhandlinginthemail.
COVERAGE,TERMS,ANDLIMITATIONSARESUBJECTTOCHANGE.
PleaseconsulttheIMMforadditionallimitationsandtermsofcoverage.
CLAIMS:Toinitiateaninquiryforloss,damage,ormissingcontents,calltheInternationalInquiryCenterat800-222-1811.
Tomakeaclaimforpostagerefundsasaresultofdelayeddeliveryaftertheguaranteeddeliverydate,themailermustmaketheclaimwithin30daysofthedateofmailing.
Tomakeaclaimforloss,damage,ormissingcontents,themailermustmaketheclaimwithin90daysofthedateofmailing.
Tomakeaclaimfordamageormissingcontents,theaddresseemustfiletheclaimimmediately,andmustpresentthearticle,containers,packaging,andallcontentsreceivedtothedestinationpostaladministration.
Insupportofallclaims,themailermustsubmitevidenceofmailing(e.
g.
,originalmailingreceiptsorwrapper),evidenceofinsurance,andevidenceofvalue(e.
g.
,salesreceiptorrepairestimate).
SeetheIMMforcompleteregulations.
PRIVACYACTSTATEMENT:Yourinformationwillbeusedtosatisfyreportingrequirementsforcustomspurposes.
Collectionisauthorizedby39U.
S.
C.
401,403,404,and407;13U.
S.
C.
301–307;and50U.
S.
C.
1702.
Providingtheinformationisvoluntary,butifnotprovided,wemaynotprocessyourtransaction.
Wedonotdiscloseyourinformationtothirdpartieswithoutyourconsent,excepttofacilitatethetransaction,toactonyourbehalforrequest,oraslegallyrequired.
Thisincludesthefollowinglimitedcircumstances:toacongressionalofficeonyourbehalf;tofinancialentitiesregardingfinancialtransactionissues;toaU.
S.
PostalServiceauditor;toentities,includinglawenforcement,asrequiredbylaworinlegalproceedings;tocontractorsandotherentitiesaidingustofulfilltheservice(serviceproviders);todomesticandinternationalcustomspursuanttofederallawandagreements;andtoothergovernmentalentitieswithauthorityoverexportation.
Formoreinformationregardingourprivacypolicies,visitusps.
com/privacypolicy.
IMPORTANT:Savethisreceiptandpresentitwhenmakinganinquiry.