INTERNATIONAL/U.S. TERRITORY SHIPMENT ATTESTATION

FOR INTERNATIONAL/U.S. TERRITORY SHIPMENTS NOT PROCESSED THROUGH FIU MAIL SERVICES, SHIPPERS MUST COMPLETE THIS FORM PRIOR TO SHIPPING. YOU MUST RETAIN THIS FORM AND ANY APPROVAL DOCUMENTS FOR YOUR RECORDS.

Shipper's Name: Shipper's Name: First Last
Date Date / MM / DD YYYY
Shipper's Email:
Shipper's Phone: Shipper's Phone: - ### - ### ####
Department Name:
Is this shipment to an international destination or U.S. Territory?
(U.S. Territories include Puerto Rico, American Samoa, Guam, U.S. Virgin Islands, Northern Mariana Islands, and Minor Outlying Islands)

Is this shipment to an international destination or U.S. Territory?
(U.S. Territories include Puerto Rico, American Samoa, Guam, U.S. Virgin Islands, Northern Mariana Islands, and Minor Outlying Islands) Yes No
Shipping Recipient Destination (Country/U.S. Territory):
Is this shipment destined for Iran, Syria, North Korea, Cuba, China, Russia, and/or Venezuela?

Is this shipment destined for Iran, Syria, North Korea, Cuba, China, Russia, and/or Venezuela? Yes No
Failure to obtain an export license (when required) and/or failure to correctly complete U.S. Customs filing information may result in significant criminal and monetary penalties for both individual shippers and the institution. International/U.S. Territory Shipping Reviews are completed by the Export Control Office prior to shipment. More information is available on the FIU Export Control Website.

PROCEDURE:

Step One: Read Instructions below and determine whether the International/U.S. Territory Shipment requires FIU’s Export Control Office to conduct an Export Control Review. If not, mark the Attestation that No Export Control Review is Required box below, sign and submit. If yes, proceed to step two.

Step Two: For shipments requiring an Export Control Review, you must complete the International/U.S. Territory Shipping Review Request Form online and receive approval from the Export Control Office BEFORE your shipment documentation is finalized and BEFORE the shipment is delivered to (or picked up) by any shipping service.

Step Three: Once the Export Control Review is completed and you have received Export Approval, you must retain that approval for your files.

INTERNATIONAL/U.S. TERRITORY SHIPMENTS REQUIRING EXPORT REVIEW MAY NOT BE SHIPPED UNLESS EXPORT APPROVAL IS OBTAINED.

INSTRUCTIONS:
ALL international shipments to Iran, Syria, North Korea, Cuba, China, Russia, and/or Venezuela MUST be reviewed by the Export Control Office prior to shipment.
For international shipments to countries other than those listed above, NO Export Control approval is required for the following exempted items:
• Basic laboratory supplies such as test tubes, beakers, etc. (“Basic Lab Supplies” do NOT include chemicals, materials, electronics, biologics, and/or other items developed at the University, which DO require export review.)
• Basic office supplies
• Personal items such as clothing, toiletries, beauty products, etc.
• Textiles
• Household goods
• Promotional items (ex. cups, pens, folders, sweatshirts)
• Food products
• Artwork and artifacts
• Currency
• Documents containing published/publicly available technical data or non-technical data, including but not limited to course-related academic materials, diplomas, immigration paperwork, and copies of legal documentation.

FOR ALL OTHER ITEMS being shipped to countries other than those listed above, prior export review by the Export Control Office is required.

ALL shipments to U.S. territories with a value of over $2500 MUST be reviewed by the Export Control Office prior to shipment.
Check one and sign:

Check one and sign: Attestation that No Export Control Review is Required
I certify that:
1) I have read the Instructions above; and
2) This International Shipment falls into one of the exempted items; and
3) This International Shipment is not being shipped to Iran, Syria, North Korea, Cuba, China, Russia, and/or Venezuela; or
4) This shipment is not valued at over $2500 and being shipped to a U.S. territory. I HAVE OBTAINED EXPORT CONTROL APPROVAL

Draw your signature into the box below.

Draw or Type

Clear

Full Name

Questions? Please contact the Export Control Office at export@fiu.edu.