溫蒂老實說

Each arriving traveler or head of family must provide the following information (only ONE written declaration per family is required):

1. Family Name ________First (Given)________ Middle________

2. Birth date ____Day____Month____Year

3. Number of family members traveling with you:

4. U.S. Address:

5. Passport issued by (country)

6. Passport Number

7. Country of Residence

8. Countries visited on this trip prior to U.S. arrival

9. Airline/Flight No:

10. The primary purpose of this trip is business.  ○YES ○ NO

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

12. I am/we are carrying currency or monetary instruments over $10000 U.S. or the foreign equivalent. ○ YES  ○NO

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

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

I have read the important information on the reverse side of this form and have made a truthful declaration.

SIGNATURE________________

Date________________

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. 姓氏 ________名字_______ 中間名________

2.  出生日期：

____日____ 月____年

3. 與你同行的家庭成員人數：

4. 在美國居住地址：

5. 護照發照(國家)

6. 護照號碼

7. 居住國家

8. 到美國前造訪過的國家

9. 航空公司/航班號：

10. 此次旅程的主要目的是商務？

○ 是   ○ 否

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. 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. 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. 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

我已閱讀過這表格背面之重要須知，並據實以報。

簽名________________

日期________________