Texas Form Ap 168 – Fill Out and Use This PDF

Texas Application for Customs Broker License

General Information

Who May Submit This Application

If you have been licensed by the United States Customs Service, you may submit this application to receive your Texas Customs Broker License. You must include a copy of your United States Customs Broker’s license.

Definitions

United States Customs Broker - A person licensed by the United States Customs Service to act as a custom house broker.

Texas Customs Broker License - The license issued to the United States Customs Broker, to allow the broker to issue export certifications. A license is required for each business location.

Authorized Employee - “Authorized employee” means an employee of a customs broker:

(A)who is authorized by the broker to perform customs transactions on behalf of the broker;

(B)who is compensated by the broker with a regular salary or wages;

(C)who is under the direct control and supervision of the broker; and

(D)from whose salary or wages the broker is required to and actually does deduct and withhold a tax under federal law. Business Location - Each place of business of the broker where export certification forms are fully or partially prepared. Export Certification Stamp - Stamp that is affixed to the export certification form.

Broker Fees

Broker Annual License Fees (The Customs Broker License expires on December 31 of each calendar year).

License must be renewed on or before December 31 of each year.

Annual License Fee Schedule
1st Quarter (January - March)	$300.00	3rd Quarter (July - September)	$150.00
2nd Quarter (April - June)	$225.00	4th Quarter (October - December)	$ 75.00

NOTE: A license fee is due for each business location where export certifications will be issued.

Bond Fee

The amount of the bond or security required is $5,000. (The Comptroller may require Brokers to post additional $1,000 bond or security for each location, if the Comptroller considers it necessary to ensure payment of tax, penalty and fine amounts.)

Stamp Fee

The Comptroller shall charge $1.60 for each stamp.

For Assistance

If you have any questions about this application, or any other related matter, contact your nearest Texas State Comptroller’s office. You may also call (800) 252-5555 or (512) 463-4600. Spanish speaking assistance is available upon request.

General Instructions

•Please type or print.

•Do not separate pages.

•Fill in all blanks and answer all questions completely and fully.

•Completed application and payment (made payable to State Comptroller) should be mailed to:

Comptroller of Public Accounts

111 E. 17th St.

Austin, TX 78774-0100

NOTE: No export certifications may be issued until you provide a copy of your United States Customs Broker’s License, this application has been approved and your Texas Customs Broker License has been issued.

FEDERAL PRIVACY ACT - Disclosure of your Social Security number is required and authorized under law, for the purpose of tax administration and identification of any individual affected by applicable law, 42 U.S.C. 405(c)(2)(C)(i);Tex. Govt. Code 403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable federal law.

You have certain rights under Ch.559, Government Code, to request, review and correct information we have on file about you. Contact us at the address or phone numbers listed on this form.

AP-168-1 (Rev.8-11/5)

• Please read instructions.

• Type or print.

• Do NOT write in shaded areas.

Page 1

1.Licensed Customs Broker Agreement - The applicant, in consideration of the issuance of the Texas Customs Broker License, agrees and affirms:

a.that the applicant is a responsible Licensed Customs Broker issuing valid export certifications for merchandise being exported from the United States;

b.that the export certifications will not be used in a manner that violates a provision of the Tax Code or the Comptroller’s rules;

c.that a copy of the applicant’s United States Customs Broker’s license is provided to the Texas Comptroller of Public Accounts at the time of application;

d.that the Comptroller of Public Accounts may suspend or revoke a Texas Customs Broker’s license to issue export certifications under this section for good cause;

e.to properly document the issuance of export certifications and stamps, and to purchase new stamps as described in the Comptroller’s rules;

f.that upon request, the licensed Customs Broker will make records available to the Comptroller or his authorized representative in the State of Texas and will cooperate with the Comptroller or his authorized representative in the examination of the records;

g.that copies of each employee’s power of attorney to issue export certifications in the name of the applicant are included;

h.information in this document and any attachments is true and correct to the best of my knowledge and belief; and

i.I understand that computer system passwords are confidential. I will not disclose (to any person) any password(s) which I am given or devise, and I will not write down such password(s) or post them where they may be viewed by others. I understand that I am responsible for any computer transactions performed as a result of access authorized by use of any passwords that I receive or devise. I agree to abide by all written conditions and restrictions imposed by the Comptroller’s Information Security Office. I agree NOT to attempt to circumvent the Comptroller’s computer security system. I understand that use of a password not issued specifically to me or to a group of which I am a member is expressly prohibited. I also understand that failure to observe these restrictions may constitute a Breach of Computer Security, and that such an offense may constitute a first-degree felony. Tex. Pen. Code §33.02.

Type or print name of licensed customs broker

Broker, officer or authorized agent

Date of application

WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online at http://www.Texas.gov. You may also want to contact the municipality and county in which you will conduct business to determine any local governmental requirements.

2. Legal name of applicant as registered with the United States Customs Service

For Comptroller's use only

00991

Tax type/reason

Reference no.

9

2

2

0

3. Mailing address where you will receive mail from the Texas Comptroller of Public Accounts

Street and number, P.O. Box or rural route

Taxpayer number

XAMAST

County code

City

State

County

ZIP/Postal code

•

Master phone num

add/change

4. Enter your Social Security number if you are a sole owner

XUMAST

Secondary mailing

address set-up

1

5.

Enter your Federal Employer Identification Number (FEIN), if any

XAADDR

(

)

Secondary mailing

6.

Daytime phone where applicant may be reached (area code and number)

address change

XUADDR

7. Enter the number of the license issued by the United States Customs Service

Tax type

• 092

8. Enter your Texas taxpayer number for reporting any Texas tax or your

County code

Texas Vendor Identification Number if you now have or have ever had one

•

9. Enter your email address

10. If your business is a corporation, list all principal officers. (Attach additional sheets as necessary.)

Name

Title

Phone (area code and number)

(

)

Home address

City

State

ZIP code

SSN or FEIN

Email address

Name

Title

Phone (area code and number)

(

)

Home address

City

State

ZIP code

SSN or FEIN

Email address

•

Please read instructions.

• Type or print.

• Do NOT write in shaded areas.

Page 2

11.

Legal name of applicant (same as Item 2)

Texas Customs Broker license number

Complete the following information for each active business location where export certifications will be issued.

(Attach additional sheets as necessary.)

Outlet/location set-up

12.

Business name

XALOCA

Location number

13.

Business location (street and number—do not use P.O. Box or rural route)

•

County code

City

State

ZIP code

County

T X

•

ICL/OCL

14.

Is your business located inside the boundaries of an incorporated city?

YES

NO

•

Month

Day

Year

Y or N

15.

First business date

Add responsibility

16.

Business phone (area code and number)

(

)

XASTAT

17.

Business name

Outlet/location set-up

XALOCA

18.

Business location (street and number—do not use P.O. Box or rural route)

Location number

•

City

State

ZIP code

County

T X

County code

•

19.

Is your business located inside the boundaries of an incorporated city?

YES

NO

ICL/OCL

Month

Day

Year

•

20.

First business date

(

)

Y or N

Add responsibility

21.

Business phone (area code and number)

XASTAT

22.

Business name

Outlet/location set-up

XALOCA

Location number

23.

Business location (street and number—do not use P.O. Box or rural route)

•

City

State

ZIP code

County

T

X

County code

•

24.

Is your business located inside the boundaries of an incorporated city?

YES

NO

ICL/OCL

Month

Day

Year

•

25.

First business date

Y or N

(

)

Add responsibility

26.

Business phone (area code and number)

XASTAT

27.

Business name

Outlet/location set-up

XALOCA

Location number

28.

Business location (street and number—do not use P.O. Box or rural route)

•

City

State

ZIP code

County

County code

T

X

•

29.

Is your business located inside the boundaries of an incorporated city?

YES

NO

ICL/OCL

Month

Day

Year

•

30.

First business date

Y or N

(

)

Add responsibility

31.

Business phone (area code and number)

XASTAT