| WELCOME
TO THE UNITED STATES |
|
歡迎來到美國 |
|
|
DEPARTMENT
OF THE TREASURY
UNITED STATES CUSTOMS SERVICE |
|
財政部
美國海關署 |
|
|
|
CUSTOM
DECLARATION
|
|
海關申報表
|
|
|
| Each
arriving traveler or head of family must provide the
following information (only ONE written declaration
per family is required): |
|
每位入關的旅遊者或一家之主必須提供以下資料
(一個家庭只須申報一份)： |
| 1.
Family Name ________First (Given)________
Middle________ |
|
1. 姓氏
________名字_______ 中間名________ |
| 2.
Birth date |
|
2.
出生日期： |
| ____Day____Month____Year |
|
____日____
月____年 |
| 3.
Number of family members traveling with you: |
|
3.
與你同行的家庭成員人數： |
| 4.
U.S. Address: |
|
4.
在美地址： |
| 5.
Passport issued by (country) |
|
5.
護照發照(國家) |
| 6.
Passport Number |
|
6.
護照號碼 |
| 7.
Country of Residence |
|
7.
居住國家 |
| 8.
Countries visited on this trip prior to U.S. arrival |
|
8.
到美國前造訪過的國家 |
| 9.
Airline/Flight No: |
|
9.
航空公司/航班號： |
| 10.
The primary purpose of this trip is
business.
○YES ○ NO |
|
10.
此次旅程的主要目的是商務？○
是 ○ 否 |
| 11.
I am/we are bringing fruits, plants, meats,
food, soil, birds, snails, other live
animals, farm products, or I/we have been on
a farm or ranch outside the U.S. |
|
YES
○
NO
○
|
|
|
| 11.
您攜帶水果、植物、肉類、食品、土壤、鳥類、蝸牛、其他動物和農產品，或您一直居住在美國以外的農村或牧場嗎？ |
| 是 ○ 否
○ |
|
| 12.
I am/we are carrying currency or monetary
instruments over $10000 U.S. or the foreign
equivalent. |
| YES
○
NO
○
|
|
|
| 12.
您攜帶現金或珍貴物品，其價值超過一
萬美金或相當於一萬美金的外幣嗎？ |
| 是 ○ 否
○ |
|
| 13.
I have (We have) commercial merchandise?
(articles for sale, samples used for
soliciting orders, or goods that are not
considered personal effects.) |
| YES
○
NO
○
|
|
|
| 13.
您有攜帶任何商品嗎？(販賣之商品、訂購之樣本等任何非屬私人之物品) |
| 是 ○ 否
○ |
|
| 14.
The total value of all goods I/we purchased or
acquired abroad and am/are bringing to the U.S. is
(see instructions under Merchandise on reverse side;
visitors should report value of gifts
only):$___________________ U.S. Dollars |
|
14.
您境外購買或獲得並帶入美國所有物品總價值(參看
背面商品欄目;
訪問者只須申報禮品價值): $
_________________ 美元 |
|
|
| I have
read the important information on the reverse side
of this form and have made a truthful declaration. |
|
我已閱讀過這表格背面之重要須知，並據實以報。 |
| SIGNATURE________________ |
|
簽名________________ |
| Date________________ |
|
日期________________ |
