Cbp Form 3124 PDF Details

For those seeking to navigate the complexities of securing a customs broker license in the United States, understanding the CBP Form 3124 is essential. As part of the Department of Homeland Security, U.S. Customs and Border Protection (CBP) mandates this form for individuals and organizations aiming to obtain a license to operate as customs brokers. It serves as a comprehensive application that covers various aspects of eligibility and requirements set forth under 19 U.S.C. 1641 and 19 CFR 111.12. The form is designed to ascertain an applicant's suitability for a broker's license through detailed information, including personal data, business affiliations, previous applications for a customs broker's license, and any past legal issues that might affect their eligibility. Additionally, it requires disclosure of any financial instabilities such as bankruptcy or tax liens that could influence their reliability as a broker. The form goes further to differentiate between individual applicants and entities like partnerships, corporations, or associations, each with specific sections to complete, ensuring a tailored approach to different types of applicants. With the expiration date and OMB approval number prominently displayed, applicants are reminded of the form's validity and the legal authority behind its requirements. Furthermore, the form includes notices concerning privacy and the Paperwork Reduction Act, ensuring applicants are aware of how their information will be used and protected. Whether for individuals, partnerships, corporations, or associations, the CBP Form 3124 is a critical step in the process of becoming a licensed customs broker, providing a structured pathway for applicants to demonstrate their qualifications and readiness to comply with the regulatory responsibilities of the role.

QuestionAnswer
Form NameCbp Form 3124
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescbp application license, form customs broker, form application customs broker, cbp form application

Form Preview Example

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

APPLICATION FOR

CUSTOMS BROKER LICENSE

19 U.S.C. 1641; 19 CFR 111.12

OMB APPROVAL NO. 1651-0034 EXPIRATION DATE 12/31/2020

See back of form for Paperwork Reduction Act Notice.

1.APPLICANT'S NAME AND ADDRESS (Principal Office) (Indicate fictitious name, if applicable)

INSTRUCTIONS: Applicants must be United States citizens. Pursuant to the requirements of 19CFR 111.12 (b) the information contained in Blocks 1,2,3,22 and 23 may be released to the public and posted by appropriate electronic means. Submit application in duplicate to the Port Director of the Port name in Block 3. All additional continuation sheets, if required, and attachments should be in duplicate

2. TYPE OF LICENSE APPLIED FOR

Individual

Corporation

Partnership

Association

3. CBP PORT

 

4. HAVE YOU EVER APPLIED FOR A CUSTOMS BROKER'S LICENSE?

 

 

NO

YES (Explain in Block 18)

 

 

5. HAS THE APPLICANT (OR ANY OFFICER, MEMBER, OR

6. IS THE APPLICANT (OR ANY OFFICER, MEMBER OR PRINCIPAL THEREOF

PRINCIPAL THERE OF AS IDENTIFIED IN BLOCK 22) EVER HAD A

AS IDENTIFIED IN BLOCK 22) AN OFFICER OR EMPLOYEE OF THE

LICENSE SUSPENDED, REFUSED, REVOKED, OR CANCELLED?

UNITED STATES?

NO

YES (Explain in Block 18)

NO

YES (Explain in Block 18)

 

 

 

 

SECTION I - INDIVIDUALS ONLY

7. DATE OF BIRTH

8.BIRTHPLACE (City & State)

9. SOCIAL SECURITY NO.

10. HOME PHONE NO.

11. BUSINESS PHONE NO.

12.U.S. CITIZENSHIP NATURAL-BORN

NATURALIZED: Give Date and Place

13.HAVE YOU EVER BEEN ARRESTED, CHARGED, CONVICTED OF OR FORFEITED COLLATERAL FOR, ANY FELONY, MISDEMEANOR, OR OTHER VIOLATION?

(You may omit: 1. traffic violations for which you paid a fine of $250 or less; 2. any incident which happened before your 16th birthday. All other incidents must be included, even though the case records were expunged or suppressed under a rehabilitation program, or you were sentenced under a State statute which provides that you need not report the incident when applying for employment, a license, etc.)

NO

YES (Explain in Block 18)

14.RESIDENCE ADDRESS (If different from Block 1; if same, write "SAME")

15.IN THE LAST 5 YEARS, HAVE YOU, OR A COMPANY OVER WHICH YOU EXCERCISED SOME CONTROL, FILED FOR BANKRUPTCY, BEEN DECLARED BANKRUPT, BEEN SUBJECT TO A TAX LIEN, OR HAD LEGAL JUDGEMENT RENDERED AGAINST YOU FOR A DEBT?

NO

YES (Explain in Block 18)

16. DO YOU PROPOSE TO ENGAGE IN THE BUSINESS OF A CUSTOMS BROKER: (More than one may apply. Explain answers in Block 18.)

(a)

(b)

(c)

(d)

(e)

ON YOUR OWN INDIVIDUAL ACCOUNT? (State name in which business is to be conducted; if trade name, state authority for use of the name and attach evidence of such authority.)

AS A MEMBER OF A PARTNERSHIP? (State name of partnership and list names of all the partners.)

AS AN OFFICER OF AN ASSOCIATION? (State name of the association, the title of the office you hold, and the general nature of your duties.)

AS AN OFFICER OF A CORPORATION? (State name of the corporation, the title of the office you hold, and the general nature of your duties.)

AS AN EMPLOYEE? (State name and address of your employer [if different from Block 1; write "SAME"] and the nature of your employment.)

17. LIST THE NAMES, ADDRESSES, AND PHONE NUMBERS OF SIX REFERENCES

18.REMARKS (In responding to questions above, include Block no. If more space is needed continue on blank sheet of paper.)

CBP Form 3124 (07/14)

Page 1 of 2

SECTION II -- FOR ASSOCIATION, CORPORATION, OR PARTNERSHIP ONLY

19. DATE APPLICANT WAS ORGANIZED

20. STATE WHERE ORGANIZED

21. ATTACHMENTS

Copy of articles of incorporation or association

Evidence of the partnership (copy of the articles of agreement or affidavit signed by all partners)

22.LIST THE NAMES, ADDRESSES, TITLES, AND DATES AND PLACES OF BIRTH OF ALL OFFICERS OF THE ASSOCIATION OR CORPORATION, AND ALL PRINCIPALS WHO HAVE A CONTROLLING INTEREST (Example: 10% or more of stock), WHO HOLD INDIVIDUAL CUSTOMS BROKERS' LICENSES AND GIVE THE GENERAL NATURE OF DUTIES OF EACH, OR IF A PARTNERSHIP, LIST NAME AND ADDRESS OF MEMBERS WHO HOLD SUCH LICENSES.

23.LIST THE NAMES, ADDRESSES, TITLES, AND DATES AND PLACES OF BIRTH OF ALL OFFICERS AND PRINCIPALS (INCLUDING CORPORATIONS, TRUSTS, AND/OR OTHER ORGANIZATIONS) WHO HAVE A CONTROLLING INTEREST, IF NOT LISTED IN BLOCK 23 (Example: 10% or more of stock), AND PARTNERS WHO DO NOT HOLD CUSTOMS BROKERS' LICENSES.

SECTION III -- CERTIFICATION (ALL APPLICANTS)

(WARNING: Any misstatement of pertinent facts in this application constitutes sufficient grounds for denial of the application.)

 

INDIVIDUAL

I,

,

certify that the statements contained in the foregoing application and supporting attachments thereto are true and correct to the best of my knowledge and belief. Written notice of any change in my mailing address, any business connection, or the name and style under which I conduct my business will be given to the Commissioner of Customs and Border Protection.

 

ASSOCIATION, CORPORATION, OR PARTNERSHIP

I,

, certify that I am an officer or partner of the

applicant; that I am a licensed Customs broker; and that the statements contained in the foregoing application and supporting attachments thereto are true and correct to the best of my knowledge and belief. The officers and partners who are licensed customs brokers are aware of the requirements for the exercise by them of responsible supervision and control of the transactions of the CBP business of the applicant. Written notice of any change in the applicant's mailing address, name, licensed officers or partners, or the charter, certificate, articles, or other instrument of organization of the applicant will be given to the Commissioner of Customs and Border Protection.

25. SIGNATURE

26. DATE

Privacy Act Notice: Pursuant to the requirements of Public Law 93-579 (Privacy Act of 1974), as amended, notice is hereby given in accordance with 5 U.S.C. 552a(e)(3) that the authority to collect information on CBP Form 3124 is 19 U.S.C. 1641; 5 U.S.C. 301; Reorganization plan no. 1 of 1950; Treasury Department Order No. 165, Revised, as amended; 19 CFR Part 111. The principal purpose for collecting the information is to enable the U.S. Customs and Border Protection to conduct a background investigation on the applicant and thereby determine whether the applicant meets the criteria established for the issuance of a Customs broker's license. The information, collected and contained in the applicant's file, may be provided to those employees of the U.S Department of Homeland Security, U.S. Customs and Border Protection who have a need for the records in the performance of their duties. The information may also be used, when deemed appropriate, to recommend to the Commissioner of U.S. Customs and Border Protection that disciplinary action be initiated, and further provide to the Department of Justice for its use in connection with appeals from orders resulting in the suspension or revocation of licenses. Similarly the information may be furnished to other government agencies which have an interest in the broker or in the situation that led to the disciplinary action.

Disclosure of the requested information including the Social Security number (SSN) is voluntary. The SSN will be used as an identifier in conducting a background investigation and will be used as an identifier throughout the career of the Customs broker. Failure to provide any or all of the information requested may result in the CBP inability to conduct the background investigation as required prior to the issuance of a license. Pursuant to the requirements of 19CFR 111.12(b) the information contained in Blocks 1,2,3,22 and 23 may be released to the public and posted by appropriate electronic means.

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0034 The estimated average time to complete this application is 1 hour. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 90K Street, NE., Washington DC 20229.

CBP Form 3124 (07/14)

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Completing this form needs focus on details. Make sure each and every field is filled out correctly.

1. The cbp form 3124 involves particular information to be entered. Be sure the subsequent blank fields are complete:

Stage # 1 of submitting uscbp form 3124

2. When this part is filled out, proceed to type in the applicable information in all these: HAVE YOU EVER BEEN ARRESTED, YES Explain in Block, IN THE LAST YEARS HAVE YOU OR A, YES Explain in Block, DO YOU PROPOSE TO ENGAGE IN THE, ON YOUR OWN INDIVIDUAL ACCOUNT, AS A MEMBER OF A PARTNERSHIP State, AS AN OFFICER OF AN ASSOCIATION, AS AN OFFICER OF A CORPORATION, AS AN EMPLOYEE State name and, LIST THE NAMES ADDRESSES AND, and REMARKS In responding to.

uscbp form 3124 conclusion process described (part 2)

Always be very careful when filling out REMARKS In responding to and YES Explain in Block, because this is where a lot of people make errors.

3. In this particular stage, check out DATE APPLICANT WAS ORGANIZED, STATE WHERE ORGANIZED, ATTACHMENTS Copy of articles of, Evidence of the partnership copy, LIST THE NAMES ADDRESSES TITLES, and LIST THE NAMES ADDRESSES TITLES. All of these will have to be taken care of with utmost attention to detail.

Step no. 3 in filling in uscbp form 3124

4. Filling in WARNING Any misstatement of, SECTION III CERTIFICATION ALL, INDIVIDUAL, ASSOCIATION CORPORATION OR, I certify that the statements, and I certify that I am an officer or is essential in the fourth step - you should definitely be patient and be mindful with each field!

Stage no. 4 for filling in uscbp form 3124

5. And finally, the following final section is what you will need to finish before submitting the form. The blanks in question are the next: I certify that the statements, I certify that I am an officer or, SIGNATURE, DATE, Privacy Act Notice Pursuant to the, Disclosure of the requested, Paperwork Reduction Act Statement, CBP Form, and Page of.

Stage number 5 in submitting uscbp form 3124

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