Form Ps 2976 B PDF Details

Form Ps 2976 B is a form that you may need to fill out in order to receive a refund for an overpayment of state taxes. The form can be downloaded from the New York State Department of Taxation and Finance website, and must be filled out and submitted along with any required documentation. If you have any questions about how to complete the form or what else you may need to submit, please contact the department for assistance.

You'll find information about the type of form you intend to fill out in the table. It can tell you how long it will take to finish form ps 2976 b, what fields you will need to fill in and a few further specific facts.

QuestionAnswer
Form NameForm Ps 2976 B
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other names2976 mail, form 2976 b, ps 2976 printable, form ps 2976

Form Preview Example

Priority Mail Express International Shipping Label and Customs Form

INSTRUCTIONS FOR COMPLETING THIS FORM (Remove this page prior to completing the form.)

Please print this form in English using blue or black ink, pressing firmly so all information transfers to all copies. Complete the declaration fully and legibly; otherwise, delay and inconvenience may result for the addressee. A false or misleading declaration may lead to a fine 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, certificate of origin, health certifi- 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.

FROM (Sender information) and TO (Addressee information) sections: Enter both the sender’s and addressee’s full name and full address in the blocks provided. Incomplete names (e.g., initials) or incomplete address entries may result in delayed handling by Customs and/or the delivery office. Provide the telephone/fax number or email address of both the sender and addressee, as such information will facilitate customs clearance and delivery.

Block 1: Enter, if applicable, a USPS corporate account (USPSC ) number, federal agen- cy account number, or Postal Service account number for payment by account.

Block 2: Check each box that applies to specify each category of each item. If the inter- national 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.

Block 3: Enter an Automated Export System (AES) Internal Transaction Number (ITN), AES Exemption, or if applicable, an AES Downtime Citation. One of these codes must appear in the “AES/ITN/Exemption” block before the Postal Service will accept a package for mail- ing. 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 fil- ing must have an AES Exemption. 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 file electronically through the Census Bureau’s AES, or for additional information, please visit www.census.gov/foreign-trade/aes or call 800-549-0595. For additional information, refer to U.S. Postal Service® Publication 699, Special Requirements for Shipping Internationally, and to IMM Subchapter 520.

AES Exemption: In order to comply with the U.S. Census Bureau’s Foreign Trade Regulations, indicate “NOEEI § 30.37(a),” if applicable. “NOEEI § 30.37(a)” may be used when the value of each class of goods is $2,500 or less, if an export license is not required. Do NOT use this AES Exemption for items sent to Cuba, Iran, North Korea, Sudan, or Syria. Further information is available in IMM Parts 526 and 527.

Block 4: Enter a detailed description of each article — e.g., “men’s cotton shirts.” General descriptions — e.g., “samples,” “food products,” or “toiletries” — are not acceptable. If there is insufficient space on the form to list all articles, use additional forms as needed

on the first form (to the right of the barcode), write the following: “Additional forms enclosed.” Important: On each subsequent form, obliterate the tracking number and bar-

code. Then place all forms into PS Form 2976- (plastic envelope).

Blocks 5–7: Enter the quantity, net weight (in pounds and ounces), and value (in U.S. dol- lars) of each article.

Blocks 8–9: In Block 8, enter, if known, the 6-digit Harmonized Tariff Schedule number, which is based on the Harmonized Commodity Description and Coding System devel- oped by the World Customs Organization. In Block 9, enter, if known, the “Country of Origin,” which is the country where the goods originated — e.g., where they were pro- duced/manufactured or assembled.

Block 10: Enter the total weight (in pounds and ounces) of the package, including pack- aging (the total weight is used to calculate postage), and enter the total value in U.S. dollars.

Block 11: Sign and date the form. Your signature certifies that all entries are correct and the item(s) being mailed contain no undeclared dangerous, prohibited, or restricted con- tents per postal, customs, or destination country regulations. Your signature also certifies compliance with all applicable federal export licensing and filing regulations and confirms your liability for the item(s) being mailed.

Blocks 12–13: Enter the Sender’s Customs Reference and Importer’s Reference, if appli- cable. (The Importer’s Reference might be a tax code, importer code, or VAT number used for sales tax.)

Blocks 14–16: Enter the License number, Certificate number, and/or Invoice number, if applicable.

Insert the completed form(s) into PS Form 2976-E, Customs Declaration Envelope — CP 91. Enclose any commercial documents in the envelope. Do not fold the form set or wrap it around the package. The entire barcode and all information must be visible. Remove the backing sheet and affix the envelope to the package on the address side.

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

Instructions for completing this form

Priority Mail Express International Shipping Label and Customs Form

SENDER’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

ACCEPTANCE INFORMATION

From: Sender’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

Item Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

Insured Amount (U.S. $)

 

Insurance Fee (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceded with URB.)

 

 

 

Postage (U.S. $)

 

Total Postage/Fees (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

City

 

 

 

 

 

 

 

 

 

State

ZIP Code™

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. USPS Corporate Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

Office of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESSEE’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

 

Time

To: Addressee’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scheduled Delivery Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DELIVERY INFORMATION

Address (Number, street, suite, apt., P.O. Box, etc.)

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

 

Time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal Code

 

 

 

 

 

 

City

 

 

 

 

 

Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province

 

 

 

 

 

 

Country (Full name, not abbreviation)

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

12. Sender’s Customs Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Check All

Gift

Documents

Merchandise

Returned Goods

Commercial Sample

3. AES / ITN / Exemption

 

 

 

13. Importer’s Reference

 

 

 

 

 

 

 

 

That Apply:

HUMANITARIAN DONATION

Dangerous Goods Other ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

14. License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Detailed Description of Contents (Enter one item per line)

5. QTY

6. Weight

7. Value

8. HS Tariff No.

9. Country of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

Lbs. Ozs.

(U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Invoice No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Office Date Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. TOTAL:

 

 

 

 

 

 

 

 

 

 

 

11. I certify the particulars given in this customs declaration are correct. This item does not contain

 

Signature

 

 

 

Date (Month/Day/Year)

 

 

 

any undeclared dangerous articles, or articles prohibited by legislation or by postal or customs

 

 

 

 

 

 

 

 

 

 

regulations. I have met all applicable export filing requirements under federal law and regulations.

 

 

 

 

 

 

 

 

 

 

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

 

 

 

 

 

 

 

 

 

 

1 – Customs Declaration

Priority Mail Express International Shipping Label and Customs Form

SENDER’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

ACCEPTANCE INFORMATION

From: Sender’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

Item Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

Insured Amount (U.S. $)

 

Insurance Fee (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceded with URB.)

 

 

 

Postage (U.S. $)

 

Total Postage/Fees (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

City

 

 

 

 

 

 

 

 

 

State

ZIP Code™

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. USPS Corporate Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

Office of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESSEE’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

 

Time

To: Addressee’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scheduled Delivery Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DELIVERY INFORMATION

Address (Number, street, suite, apt., P.O. Box, etc.)

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

 

Time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal Code

 

 

 

 

 

 

City

 

 

 

 

 

Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province

 

 

 

 

 

 

Country (Full name, not abbreviation)

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

12. Sender’s Customs Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Check All

Gift

Documents

Merchandise

Returned Goods

Commercial Sample

3. AES / ITN / Exemption

 

 

 

13. Importer’s Reference

 

 

 

 

 

 

 

 

That Apply:

HUMANITARIAN DONATION

Dangerous Goods Other ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

14. License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Detailed Description of Contents (Enter one item per line)

5. QTY

6. Weight

7. Value

8. HS Tariff No.

9. Country of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

Lbs. Ozs.

(U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Invoice No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Office Date Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. TOTAL:

 

 

 

 

 

 

 

 

 

 

 

11. I certify the particulars given in this customs declaration are correct. This item does not contain

 

Signature

 

 

 

Date (Month/Day/Year)

 

 

 

any undeclared dangerous articles, or articles prohibited by legislation or by postal or customs

 

 

 

 

 

 

 

 

 

 

regulations. I have met all applicable export filing requirements under federal law and regulations.

 

 

 

 

 

 

 

 

 

 

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

 

 

 

 

 

 

 

 

 

 

2 – Customs Declaration

Priority Mail Express International Shipping Label and Customs Form

SENDER’S INFORMATION

 

 

 

 

 

 

 

 

 

 

ACCEPTANCE INFORMATION

From: Sender’s Last Name

 

 

 

First Name

 

 

 

MI

Item Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

Insured Amount (U.S. $)

Insurance Fee (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceded with URB.)

 

 

 

Postage (U.S. $)

Total Postage/Fees (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

City

 

 

 

 

 

 

 

State

ZIP Code™

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. USPS Corporate Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

Office of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESSEE’S INFORMATION

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

Time

To: Addressee’s Last Name

 

 

 

First Name

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scheduled Delivery Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DELIVERY INFORMATION

Address (Number, street, suite, apt., P.O. Box, etc.)

 

 

 

 

 

 

 

 

 

Declaration by Addressee:

 

 

 

 

 

 

 

 

 

 

 

 

 

I have received the item(s) described on this note.

 

 

 

 

 

 

 

 

 

 

 

 

 

Addressee’s Signature

 

Postal Code

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province

 

 

 

 

 

Country (Full name, not abbreviation)

 

 

 

_______________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Check All

Gift

Documents

Merchandise

Returned Goods

Commercial Sample

3. AES / ITN / Exemption

 

 

 

Please affix labels here when required.

 

 

 

 

 

That Apply:

HUMANITARIAN DONATION

Dangerous Goods Other ______________________________

 

 

 

 

 

 

 

Office of Exchange

 

 

 

 

 

 

 

 

Customs Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Invoice No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Office Date Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Customs Duty

 

 

 

 

 

 

 

 

 

 

 

11. I certify the particulars given in this customs declaration are correct. This item does not contain

Signature

 

 

Date (Month/Day/Year)

 

 

any undeclared dangerous articles, or articles prohibited by legislation or by postal or customs

 

 

 

 

 

 

 

 

regulations. I have met all applicable export filing requirements under federal law and regulations.

 

 

 

 

 

 

 

 

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

 

 

 

 

 

 

 

 

 

3 – Dispatch Note

Priority Mail Express International Shipping Label and Customs Form

SENDER’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

ACCEPTANCE INFORMATION

From: Sender’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

Item Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

Insured Amount (U.S. $)

Insurance Fee (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceded with URB.)

 

 

 

Postage (U.S. $)

Total Postage/Fees (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

City

 

 

 

 

 

 

 

 

 

State

ZIP Code™

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. USPS Corporate Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

Office of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESSEE’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

Time

To: Addressee’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scheduled Delivery Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DELIVERY INFORMATION

Address (Number, street, suite, apt., P.O. Box, etc.)

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

Time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal Code

 

 

 

 

 

 

City

 

 

 

 

 

Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province

 

 

 

 

 

 

Country (Full name, not abbreviation)

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

12. Sender’s Customs Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Check All

Gift

Documents

Merchandise

Returned Goods

Commercial Sample

3. AES / ITN / Exemption

 

 

 

13. Importer’s Reference

 

 

 

 

 

 

That Apply:

HUMANITARIAN DONATION

Dangerous Goods Other ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

14. License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Detailed Description of Contents (Enter one item per line)

5. QTY

6. Weight

7. Value

8. HS Tariff No.

9. Country of Origin

 

 

 

 

 

 

 

 

 

 

 

Lbs. Ozs.

(U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Invoice No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Office Date Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. TOTAL:

 

 

 

 

 

 

 

 

 

 

11. I certify the particulars given in this customs declaration are correct. This item does not contain

 

Signature

 

 

 

Date (Month/Day/Year)

 

 

any undeclared dangerous articles, or articles prohibited by legislation or by postal or customs

 

 

 

 

 

 

 

 

 

regulations. I have met all applicable export filing requirements under federal law and regulations.

 

 

 

 

 

 

 

 

 

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

 

 

 

 

 

 

 

 

 

 

4 – Post Office Copy

Priority Mail Express International Shipping Label and Customs Form

SENDER’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

ACCEPTANCE INFORMATION

From: Sender’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

Item Weight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

Insured Amount (U.S. $)

Insurance Fee (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceded with URB.)

 

 

 

Postage (U.S. $)

Total Postage/Fees (U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

$

City

 

 

 

 

 

 

 

 

 

State

ZIP Code™

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. USPS Corporate Acct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

Office of Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESSEE’S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

Time

To: Addressee’s Last Name

 

 

 

 

First Name

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scheduled Delivery Date (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Name (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DELIVERY INFORMATION

Address (Number, street, suite, apt., P.O. Box, etc.)

 

 

 

 

 

 

 

 

 

 

 

Date (Month/Day/Year)

Time

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postal Code

 

 

 

 

 

 

City

 

 

 

 

 

Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province

 

 

 

 

 

 

Country (Full name, not abbreviation)

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone / Fax Number or Email Address

 

 

 

 

 

 

 

 

 

 

 

12. Sender’s Customs Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Check All

Gift

Documents

Merchandise

Returned Goods

Commercial Sample

3. AES / ITN / Exemption

 

 

 

13. Importer’s Reference

 

 

 

 

 

 

That Apply:

HUMANITARIAN DONATION

Dangerous Goods Other ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

14. License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Detailed Description of Contents (Enter one item per line)

5. QTY

6. Weight

7. Value

8. HS Tariff No.

9. Country of Origin

 

 

 

 

 

 

 

 

 

 

 

Lbs. Ozs.

(U.S. $)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Invoice No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Office Date Stamp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. TOTAL:

 

 

 

 

 

 

 

 

 

 

11. I certify the particulars given in this customs declaration are correct. This item does not contain

 

Signature

 

 

 

Date (Month/Day/Year)

 

 

any undeclared dangerous articles, or articles prohibited by legislation or by postal or customs

 

 

 

 

 

 

 

 

 

regulations. I have met all applicable export filing requirements under federal law and regulations.

 

 

 

 

 

 

 

 

 

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

 

 

 

 

 

 

 

 

 

 

5 – Sender’s Copy

Priority Mail Express International Shipping Label and Customs Form

IMPORTANT: Save this receipt and present it when making an inquiry.

Service Guarantee: This service agreement does not cover Priority Mail Express International™ shipments to countries not eligible for date-specific delivery. It also excludes international shipments delayed due to customs inspections. If the mailer submits an item at a designated USPS® Priority Mail Express International acceptance location on or before the specified deposit time for date- specific delivery to the addressee, the destination post will deliver or attempt delivery to the addressee or agent before the applicable guaranteed delivery date.

The signature of the addressee’s agent or delivery employee is required upon delivery. If the destination post does not deliver or attempt delivery by the guaranteed delivery date and the mailer files a claim for a refund, the U.S. Postal Service® may refund the postage, unless the delay was caused by the following: proper detention for law enforcement purposes; strike or work stoppage; late deposit of item, forwarding, return, incorrect address, or incorrect postcode; delay or cancellation of flights; governmental action beyond the control of the Postal Service™, destination post, or air carriers; war, insurrection, or civil disturbance; breakdowns of a substantial portion of the USPS or destination post transportation network resulting from events or factors outside the control of the Postal Service or foreign postal administration; or acts of God. For details, see Mailing Standards of the United States Postal Service, Domestic Mail Manual (DMM®) Part 114, and Mailing Standards of the United States Postal Service, International Mail Manual (IMM®) Part 942.

When the destination postal administration cannot deliver an item on the first attempt, it leaves a notice for the addressee, or follows its domestic delivery standards. If it cannot deliver the item on the second attempt, it returns the item to the sender at no additional postage.

Please consult your local Priority Mail Express™ directory for information on Priority ail Express International services. See the IMM for details.

Insurance Coverage: The Postal Service provides insurance only in accordance with postal regulations in the IMM for international shipments. The IMM sets forth specific types of losses that are covered, the limitations of coverage, terms of insurance, conditions of payment, and adjudication procedures. For details, see the IMM, which is available at pe.usps.com. The IMM consists of federal regulations, and USPS personnel are NOT authorized to change or waive these regulations or grant exceptions. Limitations prescribed in the IMM provide, in part, the following:

■■The Postal Service insures the contents of Priority Mail Express International “merchandise” items (with “merchandise” defined by postal regulations) against loss, damage, or missing contents. The Postal Service includes, at no additional charge, up to $200 coverage for international shipments containing merchandise. The sender may purchase additional merchandise insurance coverage above $200, up to a maximum of $5,000. See the Individual Country Listings in the IMM for merchandise insurance limits.

■■The Postal Service insures “nonnegotiable documents” (as defined by postal indemnity regulations) against loss, damage, or missing contents up to $100 per shipment for document reconstruction, subject to additional limitations for multiple pieces lost or damaged in a single catastrophic occurrence. Document reconstruction insurance provides reimbursement for the reasonable costs incurred in reconstructing duplicates of nonnegotiable documents mailed. Document reconstruction insurance coverage above $100 per item is not available. The mailer should not attempt to purchase additional document insurance, because additional document insurance is void.

■■The Postal Service insures “negotiable items” (defined by postal regulations as items that can be converted to cash without resort to forgery), currency, or bullion up to a maximum of $15 per item.

■■Insurance coverage may vary by country and may not be available to some countries. Insurance for loss, damage, or missing contents covers the actual (depreciated) value of the contents

at the time of mailing or the cost of repairs, not to exceed the limit fixed for the insurance coverage obtained.

EXCEPTIONS: The following exceptions apply to Priority Mail Express International shipments:

■■The Postal Service does not pay indemnity for the following contents: coins; banknotes; currency notes, including paper money; securities of any kind payable to bearer; traveler’s checks; platinum, gold, and silver; precious stones; jewelry; watches; and other valuable or prohibited articles. See the IMM for complete regulations.

■■ The ostal Service does not provide coverage for consequential losses due to loss, damage, or delay of riority Mail Express International items, or for concealed damage, spoilage

of perishable items, prohibited articles, and articles improperly packaged or too fragile to withstand normal handling in the mail.

COVERAGE, TERMS, AND LIMITATIONS ARE SUBJECT TO CHANGE. Please consult the IMM for additional limitations and terms of coverage.

CLAIMS: To initiate an inquiry for loss, damage, or missing contents, call the International Inquiry Center at 800-222-1811. To make a claim for postage refunds as a result of delayed delivery after the guaranteed delivery date, the mailer must make the claim within 30 days of the date of mailing.

To make a claim for loss, damage, or missing contents, the mailer must make the claim within 90 days of the date of mailing. To make a claim for damage or missing contents, the addressee must file the claim immediately, and must present the article, containers, packaging, and all contents received to the destination postal administration. In support of all claims, the mailer must submit evidence of mailing (e.g., original mailing receipts or wrapper), evidence of insurance, and evidence of value (e.g., sales receipt or repair estimate). 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 office on your behalf; to financial entities regarding financial 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 fulfill 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.

PS Form 2976-B, July 2013

PSN 7530-17-000-0377

Reverse of Page 5 of 5, Senders’s Copy

Watch Form Ps 2976 B Video Instruction

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