Royalty Eximport - EXPORTACIÓN ELECTRÓNICA

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EXPORTACIÓN ELECTRÓNICA

1a. U.S. PRINCIPAL PARTY IN INTEREST (USPPI) (Complete name and address)*

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Zip Code*

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b. USPPI EIN (IRS) OR ID NO.*

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c. PARTIES TO TRANSACTION*

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4a. ULTIMATE CONSIGNEE*

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4b. Intermediate Consignee*

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5. End User:*

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SHIPPER: PLEASE BE SURE TO COMPLETE ALL INFORMATION IN SHADED AREAS.

FORWARDING AGENT: ROYALTY EXIMPORT, INC. 8422 N.W. 70th. STREET MIAMI - FL 33166 PH: 305.640.3030

8. LOADING PIER / TERMINAL*

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10. EXPORTING CARRIER*

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12. PORT OF UNLOADING*

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SHIPPER REQUESTS*

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Insurance*

YESNO Invalid Input

9. MODE OF TRANSPORT (specify)*

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11. PORT OF EXPORT*

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13. CONTAINERIZED (vessel only)*

YESNO Invalid Input

MAXIMUM LIABILITY*

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6. POINT (STATE) OF ORIGIN OR FTZ NO.*

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14. CARRIER IDENTIFICATION CODE*

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16. ENTRY NUMBER*

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18. IN BOND CODE*

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7. COUNTRY OF ULTIMATE DESTINATION*

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15. SHIPMENT REFERENCE NO.*

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17. HAZARDOUS MATERIALS*

YESNO Invalid Input

19. ROUTED EXPORT TRANSACTION*

YESNO Invalid Input

date*

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20. SCHEDULE B DESCRIPTION OF COMMODITIES (Use columns 22-24)

21. D/F or M*

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21. D/F or M (A)

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21. D/F or M (B)

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21. D/F or M (C)

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21. D/F or M (D)

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21. D/F or M (E)

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22. SCHEDULE B NUMBER*

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22. SCHEDULE B NUMBER (A)

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22. SCHEDULE B NUMBER (B)

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22. SCHEDULE B NUMBER (C)

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22. SCHEDULE B NUMBER (D)

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22. SCHEDULE B NUMBER (E)

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23. QUANTITY - SCHEDULE B UNIT(S)*

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23. QUANTITY - SCHEDULE B UNIT(S) (A)

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23. QUANTITY - SCHEDULE B UNIT(S) (B)

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23. QUANTITY - SCHEDULE B UNIT(S) (C)

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23. QUANTITY - SCHEDULE B UNIT(S) (D)

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23. QUANTITY - SCHEDULE B UNIT(S) (E)

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24. SHIPPING WEIGHT (kilograms)*

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24. SHIPPING WEIGHT (kilograms) (A)

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24. SHIPPING WEIGHT (kilograms) (B)

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24. SHIPPING WEIGHT (kilograms) (C)

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24. SHIPPING WEIGHT (kilograms) (D)

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24. SHIPPING WEIGHT (kilograms) (E)

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SHIPPER NOTE: IF YOU ARE UNCERTAIN OF THE SCHEDULE B COMMODITY NO., DO NOT TYPE IT IN — WE WILL COMPLETE WHEN PROCESSING THE 7525V.

We have forwarded to you the shipment described below via:*

Your track, orOther carrier (see below). Invalid Input

Pro Number*

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DECLARED VALUE FOR CARRIAGE*

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold)*

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (A)

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (B)

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (C)

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (D)

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26. VALUE (U.S. dollars, omit cents) (Selling price or cost if not sold) (E)

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SHIPPER'S INSTRUCTIONS IN CASE OF INABILITY TO DELIVER CONSIGNMENT*

AbandonDeliver to (specify)Return to shipper Invalid Input

Shipper Must Check Collect ($)*

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Truck Line:*

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27. LICENSE NO./LICENSE EXCEPTION SYMBOL/AUTHORIZATION*

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28. ECCN (when required)*

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29. Duly Authorized officer or employee*

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The USPPI authorizes the forwarder named above to act as forwarding agent for export control and customs purposes.

30. I certify that all statements made and all information contained herein are true and correct and that I have read and understand the instructions for preparation of this document, set forth in the "Correct Way to Fill Out the Shipper's Export Declaration." I understand that civil and criminal penalties, including forfeiture and sale, may be imposed for making false or fraudulent statements herein, failing to provide the requested information or for violation of U.S. laws on exportation (13 U.S.C. Sec. 305; 22 U.S.C. Sec. 401; 18 U.S.C. Sec. 1001; 50 U.S.C. App. 2410).

PLEASE SIGN THE FIRST EXPORT DECLARATION IN BOX 29 WITH PEN AND INK.

SPECIAL INSTRUCTIONS All cargo subject to inspection. I certify that this shipment does not contain any unauthorized explosives, destructive devices or hazardous materials. I consent to a search of this shipment. I am aware that this endorsement and original signature will be retained on file until the shipment along with other shipping documents is delivered.

Signature*

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Confidential - For use solely for official purposes as authorized by the Secretary of Commerce (13 U.S.C.301 (g).

Title*

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Export shipments are subject to inspection by U.S. Customs Service and/or Office of Export Enforcement.

Date:*

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Telephone No. (Include Area Code)*

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31. AUTHENTICATION (when required)*

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E-mail address*

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