International/U.S. Territory Shipping Review Request

International/U.S. Territory Shipping Review Request

Please Read: The purpose of this International/U.S. Territory Shipping Review Request Form is to identify any international/U.S. Territory shipment, which requires prior export control authorization from U.S. Government export authorities and/or special U.S. Customs filing.

Items that can ship internationally WITHOUT review/approval:
Unless the following items are shipped to Iran, Syria, Cuba, North Korea, China, Russia, Venezuela, and/or to a Restricted or Prohibited party, they do NOT require an export review, approval, or license.
• 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

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

Please complete this form as fully as possible. Questions should be directed to: export@fiu.edu

Requestor's Name: Requestor's Name: First Last
Email
Request Date: Request Date: / MM / DD YYYY
Department:
Requested on Behalf Of (if different than Requestor): Requested on Behalf Of (if different than Requestor): First Last
Sponsored Project Code (if applicable):
Recipient Name: Recipient Name: First Last
Recipient Address: Recipient Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Has the consignee(s) been screened through Visual Compliance?

Has the consignee(s) been screened through Visual Compliance? Yes No Not Sure
Item Description:
Please include a detailed description of the item(s) that will be shipped. If you know the manufacturer and model name of the item, please include it in the description.
For shipments that include multiple items, please attach a complete list of items in a Word or Excel document.

Attach Files
Please check to indicate any of the following included in the intended shipment:

Please check to indicate any of the following included in the intended shipment: Laboratory instruments Tools (of a specialized mechanical nature) Samples/prototypes (including fabricated materials) Biological materials or specimens Specialized scientific software (not including typical operational software such as Microsoft Office, Adobe, etc.) Software programs containing or constituting specialized cryptographic functionality (not including routine commercial laptop cryptographic protection) Technical data related to any of the foregoing
Does the shipment contain Hazardous Materials or controlled biologics?

Does the shipment contain Hazardous Materials or controlled biologics? Yes No
If yes, have you received approval from EHS to ship the items to the intended recipient?

If yes, have you received approval from EHS to ship the items to the intended recipient? Yes No
Does the shipment require an executed MTA prior to shipment?

Does the shipment require an executed MTA prior to shipment? Yes No
If yes, have you contacted ORED to begin the MTA process?

If yes, have you contacted ORED to begin the MTA process? Yes No
Please identify (if known) the export control classification of the items in this shipment (Provide ECCN or USML Category, or respond “Unknown”):
What is the recipient’s intended end use of the items?
Is the recipient a member of a foreign government, military, intelligence agency, and/or police unit?

Is the recipient a member of a foreign government, military, intelligence agency, and/or police unit? Yes No
Is the export intended as a permanent export or will the item be returned?
Will the recipient re-export the items to a different final recipient?

Will the recipient re-export the items to a different final recipient? Yes No Unknown
What is the estimated value of the shipment?
How do you intend to ship your item(s)?

How do you intend to ship your item(s)? FIU Mail Services UPS/FedEx Other (please specify) Other (please specify)