Group Benefits / Personal Lines
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APPLICATION FOR U. S. CUSTOMS BOND, FORM 301
Federal I.D. Number (I.R.S. #) or S.S. #
Name and Address of Firm
If Individual: FIRST, MIDDLE, LAST NAME
The Bond Will Cover
Check As Appropriate
Activity Code 3 (INTERNATIONAL CARRIER)
Airline Express Consignment NVOCC
Steamship Line Vessel Agent Other
Activity Code 3A (INSTRUMENT OF INTERNATIONAL TRAFFIC)
If An Airline...
Number of Aircrafts:
Number of Flights Per Month with Passengers Only:
Number of Flights Per Month with Cargo Only:
Number of Flights Per Month with Cargo and Passengers:
Carrier Agreement with U.S. Customs Service:
Has Taken Measures to Improve Security Practice:
Ports of Call (Foreign):
Ports of Entry (United States):
If A Steamship Line
Number of Vessels:
Number of Voyages Per Month with Passengers Only:
Number of Voyages Per Month with Cargo Only:
Number of Voyages Per Month with Cargo and Passengers:
Carrier Agreement with U.S. Customs Service:
Has Taken Measures to Improve Security Practice:
Ports of Call (Foreign):
Ports of Entry (United States):
CERTIFICATION
I CERTIFY THAT THE FACTUAL INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND ACCURATE AND IS BASED UPON THE BEST INFORMATION AVAILABLE ON THE DATE OF THE APPLICATION.
Name:
Title:
Date:
Email:
 
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