USPS Customs Declaration and Dispatch Note
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially. Instructions (page 1 of 2)
INSTRUCTIONS FOR COMPLETING THIS FORM (Remove this page before completing this form.)
Print this form in English using blue or black ink, pressing rmly
so all information transfers to all copies. Complete the declaration
fully and legibly; otherwise, the Postal Service™ may determine the
package to be unmailable. A false or misleading declaration may
lead to a ne or seizure of the item and additional penalties. You
may add a translation of the contents in a language accepted in the
destination country.
Your goods may be subject to restrictions. It is your responsibility
to comply with import and export regulations and restrictions (e.g.,
quarantine, pharmaceutical, etc.), and to determine what documents
(e.g., commercial invoice, certicate of origin, health certicate,
license, authorization for goods subject to quarantine such as plant,
animal, or food products, etc.), if any, are required in the destination
country. Check the country listings at pe.usps.com/text/imm/
immctry.htm, as well as the UPU List of Prohibited Items available at
www.upu.int/customs/en/country_list_en.pdf.
Sender Information and Addressee Information sections: In the
blocks provided, enter both the sender’s and addressee’s full rst
and last name (and middle initial, if known) and address. Incomplete
names (e.g., initials) are not acceptable. If you are shipping to an
APO/FPO/DPO or a territory of the United States, write “United
States” in the country box. Incomplete address entries may result in
delayed handling by Customs and/or the delivery ofce. If known,
provide the telephone number of the sender and addressee, as such
information will facilitate customs clearance and delivery.
Block 1: Check all applicable boxes specifying the category of the
item(s). If the international shipment contains dangerous goods that
are approved for mailing, check the box for “Dangerous Goods.”
Mailability information for international shipments is available in
Publication 52, Hazardous, Restricted, and Perishable Mail (chapter
6), and in Mailing Standards of the United States Postal Service,
International Mail Manual (IMM
®
) Part 135. (The IMM is available
online at http://pe.usps.com.)
Block 2: Enter a detailed description of each item — e.g., “men’s
cotton shirts.” General descriptions — e.g., “samples,” “food
products,” or “toiletries” — are not acceptable. If there is insufcient
space on the form to list all items, use additional forms as needed.
Blocks 3–5: Enter the quantity, net weight (in pounds and ounces),
and value (in U.S. dollars) of each item.
Block 6: Enter the total net weight, and enter the total value in U.S.
dollars.
Blocks 7–8: If known, provide the email address of the sender and
addressee, as such information will facilitate customs clearance and
delivery.
Blocks 9–12: Enter, if known and applicable, the Exporter’s and
Importer’s Reference and Telephone Number. (The references might
be a tax code, invoice number, or VAT number used for sales tax.)
Block 13–14: The mailer must complete either Block 13 or 14
before the Postal Service will accept a package for mailing. Except
for shipments to APO/FPO/DPO addresses, enter an Automated
Export System (AES) Internal Transaction Number (ITN) or an AES
Downtime Citation in Block 13, if applicable. This standard may also
apply when mailing items to, from, and between U.S. territories,
possessions, and Freely Associated States — see DMM 608.2.5.
In general, mailpieces containing any type of goods (per Schedule
B Export Codes at www.census.gov/foreign-trade/schedules/b/ )
valued at more than $2,500, or requiring an export license under
U.S. law, must have an ITN issued by the U.S. Census Bureau or an
AES Downtime Citation, subject to certain exceptions. Mailpieces
that are exempt from ling must have an AES Exemption — in
such a case, complete Block 14 by checking one of the applicable
codes or writing in the applicable code. Regardless of exemptions,
all mailpieces must have an ITN or AES Downtime Citation if
they are destined to certain countries on which the U.S. has a
comprehensive embargo. To obtain an ITN and le electronically
S A M P L E
USPS Customs Declaration and Dispatch Note
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially.
through the Census Bureau’s AES, or for additional information, visit
www.census.gov/foreign-trade/aes/index.html or call 800-549-0595.
For additional information, refer to U.S. Postal Service
®
Publication
699, Special Requirements for Shipping Internationally, and to IMM
Part 520.
AES Exemption. There are many types of situations that are
exempt. Some of the most common ones for mailers are listed
below. In order to comply with the U.S. Census Bureau’s Foreign
Trade Regulations, select an appropriate AES Exemption box
or enter another applicable exemption listed in 15 CFR 30,
AppendixC. Note: You cannot use an exemption if a shipment
requires an export license, contains a “defense article,” or involves a
party on the BIS Unveried List.
¡ NOEEI § 30.36: A shipment, regardless of value, destined to
Canada that does not require an export license.
¡ NOEEI § 30.37(a): Each type of goods in the shipment is valued
at $2,500 or less, if an export license is not required. Note: You
cannot use this exemption for shipments destined to Cuba,
Iran, North Korea, Sudan, or Syria.
¡ NOEEI § 30.37(h): An authorized gift parcel or humanitarian
donation to Crimea, Cuba, North Korea, or Sudan that does
not require an export license.
¡ NOEEI § 30.37(y): A shipment that is destined to Cuba, Iran,
North Korea, Sudan, or Syria; that contains only published
books, software, or similar media available for general
distribution to foreign libraries or similar institutions; and that
does not require an export license.
Blocks 15–17: Enter the License Number, Certicate Number,
and/or Invoice Number, if applicable.
Blocks 18–20: Enter the length, width, and height of the parcel in
inches.
Block 21: Check the appropriate box or boxes if the contents are
subject to quarantine restrictions (plant, animal, food products, etc.)
and/or sanitary/phytosanitary inspection.
Block 22: Check the appropriate box to specify instructions in case
of nondelivery. Items returned to the sender are subject to return
charges.
Block 23: Sign and date the form. Your signature certies that
all entries are correct and the item(s) being mailed contain no
undeclared dangerous, prohibited, or restricted contents per postal,
customs, or destination country regulations. Your signature also
certies compliance with all applicable federal export licensing and
ling regulations and conrms your liability for the item(s) being
mailed.
Block 24–25: Enter, if known, the 6-digit Harmonized Tariff Schedule
number, which is based on the Harmonized Commodity Description
and Coding System developed by the World Customs Organization.
Enter, if known, the “Country of Origin,” which is the country
where the goods originated — i.e., where they were produced/
manufactured or assembled.
INSTRUCTIONS FOR COMPLETING THIS FORM (Continued) (Remove this page before completing this form.)
Instructions (page 2 of 2)
S A M P L E
USPS Customs Declaration and Dispatch Note
¡ Print in English using blue or black ink.
¡ Complete all SHADED elds before acceptance.
¡ See the Privacy Notice on the reverse of Copy 4.
SHIPMENT INFORMATION (Continued) — BOXED AREA IS FOR USPS-USE ONLY
SENDER’S INFORMATION
Full Last Name Full First Name MI USPS Ofcial Use USPS Corporate Account EMS Scheduled Delivery Date
/ /
Business Name (if applicable) Sender’s Telephone Total Postage/Fees (U.S. $) Insured Value (U.S. $) Insured Fee (U.S. $)
Address-1
7. Sender’s Email Address 8. Addressee’s Email Address
Address-2 9. Exporter’s Reference (If applicable and known) 10. Exporter’s Telephone (If applicable and known)
City State ZIP Code
™
11. Importer’s Reference (If applicable and known) 12. Importer’s Telephone (If applicable and known)
ADDRESSEE’S INFORMATION
13. AES ITN (If applicable) 14. AES Exemption — NOEEI § (Check one If applicable)
Full Last Name Full First Name MI
Business Name (If applicable) Addressee’s Telephone 15. License Number (If applicable) 16. Certicate Number (If applicable) 17. Invoice Number (If applicable)
Address-1 18. Length (Inches) 19. Width (Inches) 20. Height (Inches)
Address-2 Postal Code 21. Restrictions (If applicable — check all that apply) 22. Nondelivery Instructions (Check one)
City State/Province Country 23. Sender’s Signature and Date
I certify the particulars given in this customs declaration are correct. This package does
not contain any undeclared dangerous items, or items prohibited by legislation or by
postal or customs regulations. I have met all applicable export ling requirements under
federal law and regulations.
SHIPMENT INFORMATION
1. Category of Items (Check all that apply)
2. Detailed Description of Contents
(Enter only one item per line)
3. Quantity
4. Net Weight (Ea) 5. Value (Ea) For Business Mailers, for items in Block 2 (if the information is known)
Lbs. Oz. U.S. $ 24. HS Tariff Number 25. Country of Origin
6. Total
Document Merchandise
Other Humanitarian Donation
Commercial Sample Dangerous Goods
Returned GoodsGift
§ 30.37 (a)
Other § 30.37 (y)
§ 30.36
§ 30.37 (h)
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially.
USPS
®
-USE ONLY: Place barcode label here.
Sanitary/Phytosanitary Inspection Treat as Abandoned
Quarantine Return to Sender
1 – Customs Declaration
S A M P L E
USPS Customs Declaration and Dispatch Note
¡ Print in English using blue or black ink.
¡ Complete all SHADED elds before acceptance.
¡ See the Privacy Notice on the reverse of Copy 4.
SHIPMENT INFORMATION (Continued) — BOXED AREA IS FOR USPS-USE ONLY
SENDER’S INFORMATION
Full Last Name Full First Name MI USPS Ofcial Use USPS Corporate Account EMS Scheduled Delivery Date
/ /
Business Name (if applicable) Sender’s Telephone Total Postage/Fees (U.S. $) Insured Value (U.S. $) Insured Fee (U.S. $)
Address-1
7. Sender’s Email Address 8. Addressee’s Email Address
Address-2 9. Exporter’s Reference (If applicable and known) 10. Exporter’s Telephone (If applicable and known)
City State ZIP Code
™
11. Importer’s Reference (If applicable and known) 12. Importer’s Telephone (If applicable and known)
ADDRESSEE’S INFORMATION
13. AES ITN (If applicable) 14. AES Exemption — NOEEI § (Check one If applicable)
Full Last Name Full First Name MI
Business Name (If applicable) Addressee’s Telephone 15. License Number (If applicable) 16. Certicate Number (If applicable) 17. Invoice Number (If applicable)
Address-1 18. Length (Inches) 19. Width (Inches) 20. Height (Inches)
Address-2 Postal Code 21. Restrictions (If applicable — check all that apply) 22. Nondelivery Instructions (Check one)
City State/Province Country 23. Sender’s Signature and Date
I certify the particulars given in this customs declaration are correct. This package does
not contain any undeclared dangerous items, or items prohibited by legislation or by
postal or customs regulations. I have met all applicable export ling requirements under
federal law and regulations.
SHIPMENT INFORMATION
1. Category of Items (Check all that apply)
Ofce of Exchange Customs Stamp Afx labels here when required.
Customs Duty
Document Merchandise
Other Humanitarian Donation
Commercial Sample Dangerous Goods
Returned GoodsGift
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially.
USPS
®
-USE ONLY: Place barcode label here.
Sanitary/Phytosanitary Inspection Treat as Abandoned
Quarantine Return to Sender
§ 30.37 (a)
Other § 30.37 (y)
§ 30.36 § 30.37 (h)
2 – Dispatch Note
S A M P L E
USPS Customs Declaration and Dispatch Note
¡ Print in English using blue or black ink.
¡ Complete all SHADED elds before acceptance.
¡ See the Privacy Notice on the reverse of Copy 4.
SHIPMENT INFORMATION (Continued) — BOXED AREA IS FOR USPS-USE ONLY
SENDER’S INFORMATION
Full Last Name Full First Name MI USPS Ofcial Use USPS Corporate Account EMS Scheduled Delivery Date
/ /
Business Name (if applicable) Sender’s Telephone Total Postage/Fees (U.S. $) Insured Value (U.S. $) Insured Fee (U.S. $)
Address-1
7. Sender’s Email Address 8. Addressee’s Email Address
Address-2 9. Exporter’s Reference (If applicable and known) 10. Exporter’s Telephone (If applicable and known)
City State ZIP Code
™
11. Importer’s Reference (If applicable and known) 12. Importer’s Telephone (If applicable and known)
ADDRESSEE’S INFORMATION
13. AES ITN (If applicable) 14. AES Exemption — NOEEI § (Check one If applicable)
Full Last Name Full First Name MI
Business Name (If applicable) Addressee’s Telephone 15. License Number (If applicable) 16. Certicate Number (If applicable) 17. Invoice Number (If applicable)
Address-1 18. Length (Inches) 19. Width (Inches) 20. Height (Inches)
Address-2 Postal Code 21. Restrictions (If applicable — check all that apply) 22. Nondelivery Instructions (Check one)
City State/Province Country 23. Sender’s Signature and Date
I certify the particulars given in this customs declaration are correct. This package does
not contain any undeclared dangerous items, or items prohibited by legislation or by
postal or customs regulations. I have met all applicable export ling requirements under
federal law and regulations.
SHIPMENT INFORMATION
1. Category of Items (Check all that apply)
2. Detailed Description of Contents
(Enter only one item per line)
3. Quantity
4. Net Weight (Ea) 5. Value (Ea) For Business Mailers, for items in Block 2 (if the information is known)
Lbs. Oz. U.S. $ 24. HS Tariff Number 25. Country of Origin
6. Total
Document Merchandise
Other Humanitarian Donation
Commercial Sample Dangerous Goods
Returned GoodsGift
§ 30.37 (a)
Other § 30.37 (y)
§ 30.36
§ 30.37 (h)
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially.
USPS
®
-USE ONLY: Place barcode label here.
Sanitary/Phytosanitary Inspection Treat as Abandoned
Quarantine Return to Sender
3 – Post Ofce Copy
S A M P L E
USPS Customs Declaration and Dispatch Note
¡ Print in English using blue or black ink.
¡ Complete all SHADED elds before acceptance.
¡ See the Privacy Notice on the reverse of Copy 4.
SHIPMENT INFORMATION (Continued) — BOXED AREA IS FOR USPS-USE ONLY
SENDER’S INFORMATION
Full Last Name Full First Name MI USPS Ofcial Use USPS Corporate Account EMS Scheduled Delivery Date
/ /
Business Name (if applicable) Sender’s Telephone Total Postage/Fees (U.S. $) Insured Value (U.S. $) Insured Fee (U.S. $)
Address-1
7. Sender’s Email Address 8. Addressee’s Email Address
Address-2 9. Exporter’s Reference (If applicable and known) 10. Exporter’s Telephone (If applicable and known)
City State ZIP Code
™
11. Importer’s Reference (If applicable and known) 12. Importer’s Telephone (If applicable and known)
ADDRESSEE’S INFORMATION
13. AES ITN (If applicable) 14. AES Exemption — NOEEI § (Check one If applicable)
Full Last Name Full First Name MI
Business Name (If applicable) Addressee’s Telephone 15. License Number (If applicable) 16. Certicate Number (If applicable) 17. Invoice Number (If applicable)
Address-1 18. Length (Inches) 19. Width (Inches) 20. Height (Inches)
Address-2 Postal Code 21. Restrictions (If applicable — check all that apply) 22. Nondelivery Instructions (Check one)
City State/Province Country 23. Sender’s Signature and Date
I certify the particulars given in this customs declaration are correct. This package does
not contain any undeclared dangerous items, or items prohibited by legislation or by
postal or customs regulations. I have met all applicable export ling requirements under
federal law and regulations.
SHIPMENT INFORMATION
1. Category of Items (Check all that apply)
2. Detailed Description of Contents
(Enter only one item per line)
3. Quantity
4. Net Weight (Ea) 5. Value (Ea) For Business Mailers, for items in Block 2 (if the information is known)
Lbs. Oz. U.S. $ 24. HS Tariff Number 25. Country of Origin
6. Total
Document Merchandise
Other Humanitarian Donation
Commercial Sample Dangerous Goods
Returned GoodsGift
§ 30.37 (a)
Other § 30.37 (y)
§ 30.36
§ 30.37 (h)
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially.
USPS
®
-USE ONLY: Place barcode label here.
Sanitary/Phytosanitary Inspection Treat as Abandoned
Quarantine Return to Sender
4 – Sender’s Copy
S A M P L E
USPS Customs Declaration and Dispatch Note
PS Form 2976-R, April 2016 PSN 7530-17-000-7992 IMPORTANT: This package may be opened ofcially. Privacy Notice (reverse of Copy 4)
INSURANCE AND INDEMNITY COVERAGE: Priority Mail Express
International
®
and Priority Mail International
®
parcels containing
merchandise are insured against loss, damage, or missing contents
up to $200 at no additional charge. Indemnity is limited to the
lesser of the actual value of the contents or $200. If the parcel has
been lost, or if it has been delivered to the addressee in damaged
condition or with missing contents, payment is made to the sender,
unless the sender waives the right to payment, in writing, in favor
of the addressee. Note: Merchandise insurance that provides
coverage greater than the included $200 merchandise insurance
may be available, up to a maximum limit of $5,000, depending
on country, content, and value — see IMM Exhibit 322.2 and the
Individual Country Listings for insurance availability, limitations, and
coverage. The purchase of merchandise insurance replaces the
included $200 merchandise insurance.
Priority Mail Express International and Priority Mail International
shipments containing only nonnegotiable documents are insured
against loss, damage, or missing contents up to $100 for document
reconstruction at no additional charge. No additional document
reconstruction insurance is available for purchase.
FILING CLAIMS: To initiate an inquiry for loss, damage, or missing
contents, call the International Research Group at 800-222-1811.
File international indemnity inquiries and claims for loss within the
time limits for the service purchased. File all claims for damage or
missing contents immediately, and present the item, containers,
packaging, and all contents received to the destination Post Ofce.
Submit evidence of mailing (e.g., original mailing receipts or
wrapper) and evidence of value (e.g., sales receipt or repair
estimate) in support of all claims. For complete regulations, see the
IMM at http://pe.usps.com.
EXCEPTIONS: No coverage is provided for consequential losses,
delay, concealed damage, spoilage of perishable items, items
improperly packaged, items too fragile to withstand normal
handling in the mails, or prohibited items. See Mailing Standards
of the United States Postal Service, Domestic Mail Manual (DMM
®
)
and the IMM for the specic types of losses that are covered, the
limitation on coverage, the terms of insurance or indemnity, and the
conditions of payment.
IMPORTANT: The Postal Service does not pay indemnity coverage
for Priority Mail Express International parcels containing the
following: coins; banknotes; currency notes, including paper money;
securities of any kind payable to the bearer; traveler’s checks;
platinum, gold, and silver; precious stones; jewelry; watches; and
other valuables or prohibited items. See the IMM for complete
regulations.
PRIVACY ACT STATEMENT
Your information will be used to satisfy reporting requirements for
customs purposes. Collection is authorized by 39 U.S.C. 401, 403,
404, and 407; 13 U.S.C. 301–307; and 50 U.S.C. 1702. Providing
the information is voluntary, but if not provided, we may not process
your transaction. We do not disclose your information to third
parties without your consent, except to facilitate the transaction, to
act on your behalf or request, or as legally required. This includes
the following limited circumstances: to a congressional ofce on
your behalf; to nancial entities regarding nancial transaction
issues; to a U.S. Postal Service auditor; to entities, including
law enforcement, as required by law or in legal proceedings; to
contractors and other entities aiding us to fulll the service (service
providers); to domestic and international customs pursuant to
federal law and agreements; and to other governmental entities
with authority over exportation. For more information regarding our
privacy policies, visit usps.com/privacypolicy.
S A M P L E