Ds 1504 Form – Fill Out and Use This PDF

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

Purpose		Enter PID
Official (Explain Below)		or
	Personal	Official and Personal If Newly Assigned Check Here
Carrier/Supplier		Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)					Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State			USUN	U.S. Customs Authorization
and Authorization	Approval

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

	Purpose				Enter PID
		Official (Explain Below)			or
			Personal		Official and Personal If Newly Assigned Check Here
	Carrier/Supplier				Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

Purpose		Enter PID
Official (Explain Below)		or
	Personal	Official and Personal If Newly Assigned Check Here
Carrier/Supplier		Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

Purpose		Enter PID
Official (Explain Below)		or
	Personal	Official and Personal If Newly Assigned Check Here
Carrier/Supplier		Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

Purpose		Enter PID
Official (Explain Below)		or
	Personal	Official and Personal If Newly Assigned Check Here
Carrier/Supplier		Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

To the Secretary of State - Attention: Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of international organizations, or others herein designated, based on privileges under the authority specified on the form.

Consignee

Name (First, Middle, Last)

Title

Purpose		Enter PID
Official (Explain Below)		or
	Personal	Official and Personal If Newly Assigned Check Here
Carrier/Supplier		Customs Entry or Manifest Number Air Waybill or Bill of Lading Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

Estimated burden: 15 Minutes

AUTHORITIES: The information isREQUESTsought pursuantFORto ViennaCUSTOMSConventionCLEARANCEon Diplomatic RelationsOF MERCHANDISEof 1961; Vienna Convention on Consular Relations See Page 7

of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions Act of 1982

To(22 theU.S.CSecretary. 4301-4316)ofasStateamended- Attention:. Office of Foreign Missions

It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This PURPOSE: The information solicited on this form will be used to adjudicate requests for customs clearance of merchandise.

merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of

international organizations, or others herein designated, based on privileges under the authority specified on the form.

ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other

statutorily authorized purposes as covered under STATE 36, Security RecordsPort. Thisof Clearanceinformation also may be provided to the employing foreign Name of Embassy, Legation, or International Organization (Includes U.N.)

government or international organization.

DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of customs Consignee

clearance of merchandise. Name (First, Middle, Last)

PAPERWORKTitle REDUCTION ACT STATEMENT

Purpose
*Public reporting burden for this collection of information is estimated to averageEnter15PIDminutes per response, including time required for searching
			or
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection.
Official (Explain Below)	Personal	Official and Personal	If Newly Assigned Check Here
You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the
Carrier/Supplier			Customs Entry or Manifest Number	Air Waybill or Bill of Lading Number
accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW, Washington,
DC 20008.
			Total Weight lbs. or kg.	Mail Entry Number

Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and Year.

Signature of Authorized Representative of International Organization (Includes U.N.)			Date (mm-dd-yyyy)
Embassy or Consulate Seal	U.S. Department of State	USUN	U.S. Customs Authorization
and Authorization	Approval

Date (mm-dd-yyyy)

Free Entry Requested

DS-1504

Page 7 of 7