Usps Form 3533 – Fill Out and Use

	ApplicationforRefundofFees,Products
(Useblueorblackinkandprintwithintheboxes.)	andWithdrawalofCustomerAccounts

Part 1 -Application (Customer complete and submit to local Post Office™ for processing)

Customer/Company Name

Attention

MailingAddress (Address to which the funds will be mailed)

Apt. or Suite No.

City

State

ZIP+ 4®

Telephone No. (Include area code)

Amount of Refund Request

CustomerAccount No. or Postage Meter No.

X

Signature of Customer

Date of Request (MM/DD/YYYY)

PrivacyAct Statement

Your information will be used to process and respond to your transaction. Collection is authorized by 39 USC 401, 403, 404, 410, 2008 & 31 USC 7701. Providing the information is voluntary, but if not provided, we may not process your refund request. We do not disclose your information to third parties without your consent, except to facilitate the transactions, to act on your behalf or request. We may only disclose your information as follows: in relevant legal pro- ceedings; to law enforcement when the USPS® or requesting agency becomes aware of a violation of law; to a congressional office on your behalf; to con- tractors and other entities aiding us to fulfill the service (service providers); to entities authorized to perform audits; to labor organizations as required by law; to federal, state, local or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; and to the Merit Systems Protection Board or Office of Special Counsel. For information regarding our Privacy Policy visit www.usps.com.

ValueAdded Services (AIC 541) - Refunds to mailing agents that perform value added service and submit mail at discounted rates. Thisrefund will require the Customer Tax Identification Number (TIN).

Customer TIN#

Part 2 - Verification of Disbursements (This area is for Official use only)

Print Contact Name

Certifying Employee Signature

Date

Witness Signature

Date

PS Form 3533,November 2006 (Page 1 of 2) PSN 7530-01-000-9932

Part 3 - Postage or Meter Stamps (excluding PCPostage®)	(For Official Use Only)

The customer's meter must be licensed at the refunding office, and complete, legible, and valid unused meter stamps must be submitted by the licensee within 60 days from the dates shown on the indicia. Those produced by PC Postage systems are not refundable at the window. Charges are assessed at 10% off the face value of the indicia, if the total is $350 or less. If the total face value is more than $350, a charge of $35 per hour is assessed for the actual hours to process the refund; the minimum charge is $35.

Meter Manufacturer		Meter Serial No.			Meter License
(Group and list by postage units or value)			(Group and list by postage units or value)
Number of Pieces	Amount Each	Postage Value	Number of Pieces		Amount Each	Postage Value

Total Postage Value				Total Postage Value
				Grand Total of Postage Value	$
				Less Charges	_
	(10% of face value or $35 per hour if over $350. Minimum charge is $35.)
Post Offices must destroy customer meter stamps to prevent reuse. The manager and				Total To Be Refunded	$
a witness must sign to certify that the meter impressions listed above were destroyed.
Supervisor/Manager Signature		Date		Witness Signature	Date

Part 4 - Special Services and Other Refunds (Note: Fees for registered, insured, and COD services are not ordinarily refundable.)

Explain the reason for the requested refund:

Part 5 - Disbursements for Refunds (Issued Locally)

1)Postal Service official and witness must verify this claim and enter the approved amount in the “ApprovedAmount of Disbursement”.

2)Certifying Postal Service official and witness are required to print and sign as authorization for payment or withdrawal of trust account.

3)Ensure the proper accounting entries are performed on PSForm 1412.

4)For cash refund issued, obtain payee’s signature below. For money order refund issued enter the money order serial number below.

5)DO NOT SUBMIT PS Form 3533 to Scanning and Imaging Center if a refund is issued locally.

Payee Signature or Money Order Serial Number:	Date

Part 6 - Disbursements Processed by theAccounting Service Center (ASC)

1)Postal Service official and witness must verify this claim and enter the approved amount in the “ApprovedAmount of Disbursement”.

2)Certifying Postal Service official and witness are required to print and sign as authorization for payment or withdrawal of trust account.

3)Ensure the proper accounting entries are performed:

a)If this is a refund, use the appropriateAIC for the refund. (See “Request Disbursement For” section.)

b)If this is a withdrawal from an advance deposit account, use the appropriateAIC 453 for BRM/Postage Due orAIC 470 for permit.

c)Ensure the offset toAIC 280, Disbursement Sent toASC, is performed either in Form 1412 or Postal One!® system.

d)Attach the supportingAIC 280 documentation (PS Form 3544 or 3533-X) to the PSForm 3533.

4)SUBMIT PS Form 3533 with attachedAIC 280 supporting documentation to the USPS Scanning and Imaging Center.

5)Customer will receive the payment from USPS. NOTE: Maintain a copy of the PSForm 3533 locally for 90 days.

PS Form 3533,November 2006 (Page 2 of 2)