Free CBP Form 5297 – Power of Attorney - Federal

1. THIS FORM MUST BE TYPED. 2. DO NOT ALTER THIS FORM. 3. ORIGINAL TO BE SUBMITTED

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0050 Exp. 12/31/2010

U.S. Customs and Border Protection
SURETY POWER OF ATTORNEY
REVOCATION. The below-described powers previously granted are hereby revoked. (Instruction No. 3c.)
This is a name change
ADDRESS

CBP USE ONLY
DATE RECEIVED

CORPORATE TO CBP. (See Option explained in Instruction No. 2.) GRANT CHANGE to Grant on file (Instruction (Instruction No. 3b.) No. 3a.)
NAME

EFFECTIVE DATE

GRANTEE:
SOCIAL SECURITY NUMBER

This is an address change

GRANTOR:

SURETY COMPANY'S CORPORATE NAME

SURETY NO.

STATE UNDER WHOSE LAWS ORGANIZED AS A SURETY

Port code(s) for CBP port(s) in which authorized to do business and limit on any single oblligation -OR- port(s) being added to the original grant. LIMIT LIMIT LIMIT LIMIT LIMIT LIMIT PORT PORT PORT PORT PORT PORT

Grantor appoints the above-named person (Grantee) as its attorney in fact to sign its name as surety to, and to execute, seal, and acknowledge any bond so as to bind the surety corporation to the same extent as if done by a regularly elected officer, limited only to the extent shown above as to Customs and Border Protection port and amount on any single bond obligation. This grant, or change to a grant on file, or revocation, as specified, shall become active on the effective date shown provided the CBP Form 5297 is received at a port office 5 days before the effective date shown; otherwise the specified actions will be come active at the close of business 5 working days after the date of receipt at the port office. In witness whereof, the said Grantor, by Date Attested Name and Title Name and Title virtue of authority conferred by its Board of Directors, has caused these presents to be sealed with its corporate Use a facsimile of corporate seal and attested by any two principal seal, and not impression seal. Signature: Signature: officers.

Distribution: 3 copies

CBP Form 5297 (06/08)

U.S.Ports and Codes Anchorage,AK Baltimore,MD Boston, MA Buffalo, NY Charleston, SC Cleveland, OH Chicago, IL Dallas-Ft. Worth, TX Detroit,MI Duluth, MN El Paso, TX Great Falls, MT Honolulu, HI Houston-Galveston,TX Laredo, TX Los Angeles, CA Miami, FL Milwaukee, WI Minneapolis, MN Mobile, Al New York,NY New Orleans, LA Nogales, AZ Norfolk,VA Ogdensburg, NY Pembina, ND Philadelphia, PA Portland, ME Portland, OR Port Arthur, TX Providence, RI San Diego,CA San Francisco,CA San Juan, PR Savannah,GA St. Albans,VT St. Louis, MO Seattle, WA Tampa, FL Virgin Islands,U.S. Washington,DC Wilmington, NC 31 13 04 09 16 41 39 55 38 36 24 33 32 53 23 27 52 37 35 19 10 20 26 14 07 34 11 01 29 21 05 25 28 49 17 02 45 30 18 51 54 15

Explanations: 1. A Corporate Surety Power of Attorney, CBP Form 5297, must be executed for each of the following actions; grant an individual a power of attorney; change a name and/or address, and/or add districts to a power on file; revoke a power previous granted. 2. Form submission option: Each of the following conditions will require filing a copy of the CBP Form 5297: (a) if the port director permits the submission of the form to be made at any port within the district. (b) If the grantee desires to use the power of attorney at a location covered by the power, but other than the locations where the power was submitted, before CBP computer processing has been completed. For example: If both conditions are applicable, two copies of the CBP Form 5297 must be submitted with the original. 3. The box adjacent to the action executed on this CBP Form 5297 must be checked. The effective date for the action checked should be shown. (a) If grant is checked: The information required to grant a power of attorney are self-explanatory with the exception of the following: Port Information: Each port in which the power is granted must be shown except if the power both applies to all ports and the amount limit is the same in every one of those ports, enter the word "ALL" on the first line under "Port." Limit Information: (1) If any amount limit differs between any of the ports in which the power is granted, individual amount limits must be shown for each of the ports listed. (2) If all the amount limits are the same for each district in which the power is granted and the amounts equal the surety company limit published in the Treasury Department Circular 570, enter the word ""Equal" on the first line under "Limit." (3) If all of the amount limits are the same for each port in which the power is granted and the amounts are not equal to the surety company limit published in the Treasury Department Circular 570, enter the amount limit on the first line under "Limit" and enter the word "SAME" on the second line. Surety: The number required is the 3 digit identification code assigned by CBP Headquarters to a surety company, listed on Treasury Circular 570, at the time the surety company initially give notice to CBP that the company will be writing CBP bonds. (b) To change a Corporate Surety Power of Attorney already on file, the previously field power granted must be revoked and a new power (CBP 5297) must be filed EXCEPT changes to the name and/or address and the addition of districts to a power on file. (1) To make a name and/or address change, the same information that was submitted to establish the existing power on file is required except the new name and/or address must be shown in the space provided and the port code(s) and related obligation limit(s) can be left blank. (2) To add ports, the same information that was submitted to establish the existing power on file is required except only the new districts and related obligation limits are necessary in the space provided. (c) If revocation is checked: A revocation divests the designated agent's or attorney's power of attorney in all ports. Except for the following, the information required to revoke the power of attorney is self-explanatory: The ports in which authorized to do business and the associated single obligation limits do not have to be shown. Privacy Act Statement: The following notice is given pursuant to section 7(b) of the Privacy Act of 1974 (5 U.S.C. 552a). Furnishing the information on this form, including the Social Security Number is mandatory. The primary use of the Social Security Number is to verify, in the CBP automated system, at the time an agent submits a CBP bond for approval that the individual was granted a Corporate Surety Power of Attorney by the Surety Company on the bond. Section 7 of Act of July 30, 1947, chapter 390, 61 Stat. 646, authorizes the collection of this information. Paperwork Reduction Notice: The Paperwork Reduction Act says we must tell you why we are collecting this information, how we will use it, and whether you have to give it to us. We ask for this information to carry out U.S. Customs and Border Protection laws of the United States. We need it to ensure that persons transacting business with Customs have the proper bond coverage to secure their transactions as required by law and regulation. Your response is required to enter into any transaction in which a bond is a prerequisite under the Tariff Act of 1930, as amended. Statement Required by 5 CFR 1320.21: The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Information Services Division, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction project (1651-0050). CBP Form 5297 (06/08)