Sample b

Customs Declaration

customs use only

Department of the Treasury United States

Customs Service

Each arriving traveller or responsible family member must provide the following

information (only ONE written declaration per family is required):

1.Family Name ……………………………………………………………

2.First (Given) Name………………………………………………………

3.Middle Initial(s)………………………………………………………….

4.Birth Date (day/mo/yr)…………………………………………………...

5.Airline/Flight No. Or Vessel Name or Vehicle License No …………….

6.Number of Family Members travelling with You………………………

6. (a) Country or Citizenship………………………………………………..

7. (b) Country of Residence…………………………………………………

8. (a) U.S. Address (Street Number /Hotel/Mailing Address in U.S.)……….

9. (b) U. S. Address (City) ………………………………………………….

10. (c) U.S. Address (State) ………………………………………………….

11. Countries visited on this trip prior to U.S. arrival………………………..

12. The purpose of my (our) trip is or was Business.............Personal.......

(Check one or both boxes, if applicable)

13. I am (We are) bringing fruits, plants, metals, food,

soil, birds, snails, other live animals, wildlife products Yes No

farm products; or, have been on a farm or ranch

outside the U.S.

14. I am (We are) carrying currency or monetary

instruments over $ 10.000 U.S., or foreign Yes No

equivalent

15. I have (We have) commercial merchandise

U.S. or foreign (Check one box only) Yes No

16. The total value of all goods, including commercial

merchandise, I/we purchased or acquired abroad ………………

and am/are bringing to the U.S. is: (U.S. Dollars)

SIGN BELOW AFTER YOU READ NOTICE ON REVERSE

I have read the notice on the reverse and have made a truthful declaration.

……………….. ……………………….

Signature Date (day/month/year)

2.3.1 Translate the following sentences, words and phrases into English:

Part A