Travel Guide to USA

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Copyright Path2usa.com 2010. All rights reserved. All content available in this document, including design, text, graphical illustrations, and arrangement thereof is copyrighted by Path2usa.com, Inc., under US and international copyright laws. No part of this document may be published, copied, or reproduced

on any media without prior written permission from Path2usa.com, Inc.

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All content available in this document, including design, text, graphical illustrations, and arrangement thereof is copyrighted by Path2usa.com, Inc., under US and international copyright laws. No part of this document may be published, copied, or reproduced


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D09 34548901

DEPARTURE CARD FOR PASSENGERSPlease write in CAPITALS only. One Character in one box as shown below.Do not write across the lines. Leave one box blank for space.

1. Name (as in passport) Leave one box blank after every part of the name/initial.

2. Sex (tick appropriate box) 3. Nationality

Male Female

4. Country of Residence 5. Date of Birth (DD/MM/YY)

6. NRI/PIO/OCI Status (tick appropriate box) 7. PIO/OCI Card No., if any

NRI PIO OCI None 8. Passport Number 9. Date of Issue (DD/MM/YY)

10. Date of Boarding (DD/MM/YY) 11. Flight Number

12. Port of final destination

13. Occupation

14. Address in India

15. Telephone number

To be filled by Indians only16. Does your Passport carry an ECR stamp? (tick appropriate box)

Yes No 17. Purpose (tick appropriate box)

Business Transit Official Employment Education Conference

Visit Friends / Relatives

Medical / Health Religion / Pilgrimage

Leisure / Holiday Sport Others

Signature of Passenger Immigration Stamp

Copyright Path2usa.com 2011. All rights reserved. The above form is a sample for your reference only and should not be treated as the original. Do not submit this form. You must fill out and submit the appropriate original form provided by the government.

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U.S. Customs and Border Protection

Customs Declaration FORM APPROVED19 CFR 122 27, 148.12, 148.13, 148.110, 148.111, 1498;31 CFR 5316 OMB NO. 1651-0009Each arriving traveler or responsible family member 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 (a) U.S. Street Address (hotel name / destination)

(b) City

(c) State

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. or Vessel Name

10. The primary purpose of this trip is business Yes No11. I am (We are) bringing

(a) fruits, vegetables, plants, seeds, food, insects: Yes No

(b) meats, animals, animal/wildlife products: Yes No

(c) disease agents, cell cultures, snails Yes No

(d) soil or have been on a farm / ranch / pasture: Yes No

12. I have (We have) been in close proximity of (such as touching or handling ) livestock: Yes No13. I am (We are) carrying currency or monetary instruments over $10,000 U.S. or foreign

equivalent: (see definition of monetary instruments on reverse):Yes No

14. I have (We have ) commercial merchandise: (articles for sale, samples, used for soliciting orders, or goods that are not considered personal effects)

Yes No

15. Residents the total value of all goods, including commercial merchandise I/we have purchased or acquired abroad, (including gifts for someone else, but not items mailed to the U.S.) and am/are bringing to the U.S. is:

$

Visitors the total value of all articles that will remain in the U.S., including commercial merchandise is:

$

Read the instructions on the back of this form. Space is provided to list all the items you must declare.I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION.

(Signature) Date (day/month/year)For Official Use Only CBP Form 6059B (01/04)

Copyright Path2usa.com 2011. All rights reserved. The above form is a sample for your reference only and should not be treated as the original. Do not submit this form. You must fill out and submit the appropriate original form provided by the government.

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Travel Guide to USA