海关申请表
CUSTOM DECLARATION
海關申報表
Each arriving traveler or head of
family must provide the following information (only ONE written
declaration per family is required): 每位入關的旅遊者或一家之主必須提供以下資料 (一個家庭只須申報一份) ：
1. Family Name ________First (Given)________ Middle________ 1. 姓氏 ________名字_______ 中間名________
2. Birth date 2. 出生日期：
____Day____Month____Year ____日____ 月____年
3. Number of family members traveling with you: 3. 與你同行的家庭成員人數：
4. U.S. Address: 4. 在美地址：
5. Passport issued by (country) 5. 護照發照(國家)
6. Passport Number 6. 護照號碼
7. Country of Residence 7. 居住國家
8. Countries visited on this trip prior to U.S. arrival 8. 到美國前造訪過的國家
9. Airline/Flight No: 9. 航空公司/航班號：
10. The primary purpose of this trip is business. ○YES ○ NO 10. 此次旅程的主要目的是商務？○ 是 ○ 否
11. I am/we are bringing fruits, plants, meats, food, soil, birds, snails, other live animals, farm products, or I/we have been on a farm or ranch outside the U.S.
YES ○ NO ○
11. 您攜帶水果、植物、肉類、食品、土壤、鳥類、蝸牛、其他動物和農產品，或您一直居住在美國以外的農村或牧場嗎？ 是 ○ 否 ○
12. I am/we are carrying currency or monetary instruments over $10000 U.S. or the foreign equivalent.
YES ○ NO ○
12. 您攜帶現金或珍貴物品，其價值超過一 萬美金或相當於一萬美金的外幣嗎？ 是 ○ 否 ○
13. I have (We have) commercial merchandise? (articles for sale, samples used for soliciting orders, or goods that are not considered personal effects.)
YES ○ NO ○
13. 您有攜帶任何商品嗎？(販賣之商品、訂購之樣本等任何非屬私人之物品)
是 ○ 否 ○
14. The total value of all goods I/we purchased or acquired abroad and am/are bringing to the U.S. is (see instructions under Merchandise on
reverse side; visitors should report value of gifts
only)
___________________ U.S. Dollars 14. 您境外購買或獲得並帶入美國所有物品總價值(參看 背面商品欄目; 訪問者只須申報禮品價值): $ _________________ 美元
I have read the important information on the reverse side of this form and have made a truthful declaration. 我已閱
讀過這表格背面之重要須知，並據實以報。 SIGNATURE________________ 簽名________________
Date________________ 日期________________